Provider Demographics
NPI:1811703689
Name:MEIGHAN, EWORTH CHARLES CHARLES (NP, AGACNP-BC, RN)
Entity type:Individual
Prefix:
First Name:EWORTH CHARLES
Middle Name:CHARLES
Last Name:MEIGHAN
Suffix:
Gender:M
Credentials:NP, AGACNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 E CAROL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4196
Mailing Address - Country:US
Mailing Address - Phone:323-719-3221
Mailing Address - Fax:
Practice Address - Street 1:266 E CAROL WAY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4196
Practice Address - Country:US
Practice Address - Phone:323-719-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032977363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care