Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71008042A | IN |
NPI | 1003311309 |
---|---|
Provider Name | Megan E Mayes |
First Address | Fort Branch, IN 47648-1313 |
Second Address | Evansville, IN 47725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2018 |
Last Update Date | 09/11/2021 |