Provider Demographics
NPI:1982240453
Name:MACKINNON, MEGAN HOPE (RN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:HOPE
Last Name:MACKINNON
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 1:13 GENERAL GREENE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-7636
Mailing Address - Country:US
Mailing Address - Phone:781-718-0382
Mailing Address - Fax:
Practice Address - Street 1:13 GENERAL GREENE RD
Practice Address - Street 2:
Practice Address - City:SHELBURNE
Practice Address - State:VT
Practice Address - Zip Code:05482-7636
Practice Address - Country:US
Practice Address - Phone:781-718-0382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0140246163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse