Basic Information
| Provider Information | |||||||||
| NPI: | 1447683594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMANUS | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | DEBELL | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 GARNER RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276106666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195561008 | ||||||||
| FaxNumber: | 9195566099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 GARNER RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 27610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195561008 | ||||||||
| FaxNumber: | 9195566099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2013 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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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 | 5006367 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | MM2972924 | 01 | NC | DEA | OTHER |