Basic Information
| Provider Information | |||||||||
| NPI: | 1053662338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCGONIGAL HUSER | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | C | ||||||||
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| OtherLastName: | MCGONIGAL | ||||||||
| OtherFirstName: | MEGHAN | ||||||||
| OtherMiddleName: | C | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 355 WESTFIELD RD | ||||||||
| Address2: | STE 120 | ||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460601443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177768748 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 355 WESTFIELD RD | ||||||||
| Address2: | STE 120 | ||||||||
| City: | NOBLESVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460601443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177768748 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2012 | ||||||||
| LastUpdateDate: | 09/26/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 10001441A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.