Provider Demographics
NPI:1205076726
Name:PAULY, MEGHAN ANNETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:ANNETTE
Last Name:PAULY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:817 MELISSA ST
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-2535
Mailing Address - Country:US
Mailing Address - Phone:920-486-1813
Mailing Address - Fax:
Practice Address - Street 1:817 MELISSA ST
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-2535
Practice Address - Country:US
Practice Address - Phone:920-486-1813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2009-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165147-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse