Provider Demographics
NPI:1255715207
Name:MOREAU, MERREDITH (CNP)
Entity type:Individual
Prefix:
First Name:MERREDITH
Middle Name:
Last Name:MOREAU
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:MERREDITH
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:199 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-3088
Mailing Address - Country:US
Mailing Address - Phone:508-860-7888
Mailing Address - Fax:508-796-7053
Practice Address - Street 1:199 CHANDLER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-3088
Practice Address - Country:US
Practice Address - Phone:508-860-7888
Practice Address - Fax:508-796-7053
Is Sole Proprietor?:No
Enumeration Date:2015-07-18
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2277546363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health