Basic Information
| Provider Information | |||||||||
| NPI: | 1124514617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARRY | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 90 MONICA RD | ||||||||
| Address2: | |||||||||
| City: | LOS LUNAS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 870317172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057102260 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 711 ENCINO PL NE STE D | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871022650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052247400 | ||||||||
| FaxNumber: | 5052247404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2018 | ||||||||
| LastUpdateDate: | 01/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 53105 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | RN-74191 | 01 | NM | REGISTERED NURSE LICENSE | OTHER | 53105 | 01 | NM | ADVANCED PRACTICE LICENSE | OTHER |