Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN273431 | GA |
NPI | 1003469677 |
---|---|
Provider Name | Megan Irene Bueltel |
First Address | Cumming, GA 30041-6017 |
Second Address | Cumming, GA 30041-6017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2019 |
Last Update Date | 24/08/2020 |