Provider Demographics
NPI:1669954897
Name:WOLTER, MEGHAN MITCHELL (RN)
Entity type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:MITCHELL
Last Name:WOLTER
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 1:79 CANARAS AVE
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1590
Mailing Address - Country:US
Mailing Address - Phone:518-897-1753
Mailing Address - Fax:
Practice Address - Street 1:79 CANARAS AVE
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-1590
Practice Address - Country:US
Practice Address - Phone:518-897-1753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY660690163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool