Provider Demographics
NPI:1972062776
Name:CHYTRY, MEGHAN JOYCE (NP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:JOYCE
Last Name:CHYTRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58521 PONTIAC TRL
Mailing Address - Street 2:
Mailing Address - City:NEW HUDSON
Mailing Address - State:MI
Mailing Address - Zip Code:48165-9535
Mailing Address - Country:US
Mailing Address - Phone:734-775-0032
Mailing Address - Fax:
Practice Address - Street 1:1225 S LATSON RD STE 350
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7663
Practice Address - Country:US
Practice Address - Phone:517-546-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704285504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily