Provider Demographics
NPI:1922530948
Name:BROE, MEGAN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BROE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 N HOWARD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-3529
Mailing Address - Country:US
Mailing Address - Phone:308-398-8997
Mailing Address - Fax:308-398-8999
Practice Address - Street 1:908 N HOWARD
Practice Address - Street 2:SUITE 109
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-3529
Practice Address - Country:US
Practice Address - Phone:308-398-8997
Practice Address - Fax:308-398-8999
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112205363L00000X
NE60016163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse