Provider Demographics
NPI:1457725731
Name:MACRAE, MEAGHAN (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:MACRAE
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 VALLEY RD STE 4
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-7230
Mailing Address - Country:US
Mailing Address - Phone:401-619-8383
Mailing Address - Fax:800-579-0619
Practice Address - Street 1:333 VALLEY RD STE 4
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:RI
Practice Address - Zip Code:02842-7230
Practice Address - Country:US
Practice Address - Phone:401-619-8383
Practice Address - Fax:800-579-0619
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-24
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN00780363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health