Basic Information
Provider Information
NPI: 1730618539
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALLEN
FirstName: MEGHANN
MiddleName: REDMON
NamePrefix:  
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: REDMON
OtherFirstName: MEGHANN
OtherMiddleName: LEANNE
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 111 S FRONT ST
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171012010
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 111 S FRONT ST
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171012010
CountryCode: US
TelephoneNumber: 7177823282
FaxNumber: 7172318964
Other Information
ProviderEnumerationDate: 06/06/2017
LastUpdateDate: 01/16/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/16/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X1135549ALY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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