Provider Demographics
NPI:1912448820
Name:WATROBA, MEGAN
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:WATROBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 766
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-0766
Mailing Address - Country:US
Mailing Address - Phone:508-524-0627
Mailing Address - Fax:
Practice Address - Street 1:216 PINE RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:COTUIT
Practice Address - State:MA
Practice Address - Zip Code:02635
Practice Address - Country:US
Practice Address - Phone:508-524-0627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN265936163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse