Provider Demographics
NPI:1245861129
Name:FACELLO, MEGAN JEAN (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JEAN
Last Name:FACELLO
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1586
Mailing Address - Country:US
Mailing Address - Phone:749-296-5702
Mailing Address - Fax:
Practice Address - Street 1:135 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-1586
Practice Address - Country:US
Practice Address - Phone:749-296-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN.CNP.104883363LF0000X
OHAPRN.CNP.025883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty