Provider Demographics
NPI:1275184822
Name:POWNER, MEGHAN LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LOUISE
Last Name:POWNER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MIDSTREAMS RD
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3837
Mailing Address - Country:US
Mailing Address - Phone:732-966-5706
Mailing Address - Fax:
Practice Address - Street 1:39 SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1208
Practice Address - Country:US
Practice Address - Phone:732-530-7730
Practice Address - Fax:732-530-3837
Is Sole Proprietor?:No
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant