Provider Demographics
NPI:1770720930
Name:MCMANAMA, MEGHAN FINIGAN (MSN, NP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:FINIGAN
Last Name:MCMANAMA
Suffix:
Gender:F
Credentials:MSN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 BERKELEY ST
Mailing Address - Street 2:LIBERTY HEALTH CENTER
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-5066
Mailing Address - Country:US
Mailing Address - Phone:857-224-9355
Mailing Address - Fax:
Practice Address - Street 1:175 BERKELEY ST
Practice Address - Street 2:LIBERTY HEALTH CENTER
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-5066
Practice Address - Country:US
Practice Address - Phone:857-224-9355
Practice Address - Fax:857-224-9300
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305051363LA2200X
MARN2270126363LA2200X
NY420909363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110091002AMedicaid
MA110091002AMedicaid