Basic Information
| Provider Information | |||||||||
| NPI: | 1285119644 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOSTON | ||||||||
| FirstName: | MEAGANE | ||||||||
| MiddleName: | BRYHANN | ||||||||
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| Credential: | AGACNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 N CAMPBELL AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857191563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208383540 | ||||||||
| FaxNumber: | 5203253526 | ||||||||
| Practice Location | |||||||||
| Address1: | 5140 E GLENN ST | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857121337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5208383540 | ||||||||
| FaxNumber: | 5203253526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2018 | ||||||||
| LastUpdateDate: | 03/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 7862 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | 264843 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.