Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | F337378-1 | NY |
NPI | 1104172931 |
---|---|
Provider Name | Megan Renee Coghlan |
First Address | Liverpool, NY 13090-3141 |
Second Address | Syracuse, NY 13202-2280 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2012 |
Last Update Date | 29/08/2013 |