Provider Demographics
NPI:1396168845
Name:WAKEFIELD, MEGAN (RN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2771 SHEPPARD BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:TN
Mailing Address - Zip Code:37091-5148
Mailing Address - Country:US
Mailing Address - Phone:931-205-5646
Mailing Address - Fax:931-359-0542
Practice Address - Street 1:206 LEGION AVE
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:TN
Practice Address - Zip Code:37091-2898
Practice Address - Country:US
Practice Address - Phone:391-359-1551
Practice Address - Fax:931-359-0542
Is Sole Proprietor?:No
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000181509163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse