Provider Demographics
NPI:1376345611
Name:CHRISTIE, MEGHAN (RN, BSN, IBCLC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 CHEYENNE TRL
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-7804
Mailing Address - Country:US
Mailing Address - Phone:321-607-1447
Mailing Address - Fax:
Practice Address - Street 1:1680 S FISKE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-2535
Practice Address - Country:US
Practice Address - Phone:321-866-8484
Practice Address - Fax:321-333-5696
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9264723163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant