Doctor Name: | MEGAN CANAVAN |
NPI Number: | 1063870970 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 26NJ00616800 |
Business Practice Address: | 3201 Marne Hwy Mount Laurel, NJ - 080549716 |
Business Phone Number: | 8562352147 |
Business Fax Number: | |
Mailing Address: | 3201 Marne Hwy, MOUNT LAUREL |
State: | NJ |
Postal Code: | 080549716 |
Phone Number: | 8562352147 |
Fax Number: | |
NPI Enumeration Date: | 02/05/2016 |
NPI Last Update Date: | 02/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP2300X |
License Number: | 26NJ00616800 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |