Basic Information
Provider Information
NPI: 1598160640
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PRICE
FirstName: MEGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: CRNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 S 11TH ST
Address2: 934 THOMPSON
City: PHILADELPHIA
State: PA
PostalCode: 191074824
CountryCode: US
TelephoneNumber: 2159556000
FaxNumber:  
Practice Location
Address1: 111 S 11TH ST
Address2: 934 THOMPSON
City: PHILADELPHIA
State: PA
PostalCode: 191074824
CountryCode: US
TelephoneNumber: 2159556000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/31/2014
LastUpdateDate: 10/31/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000X626267PAN Nursing Service ProvidersRegistered Nurse 
363LA2100XSP014387PAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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