Provider Demographics
NPI:1215505466
Name:MIDDLECOAT, MEGAN DIANE (RN)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:DIANE
Last Name:MIDDLECOAT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ILLINI LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62439-3366
Mailing Address - Country:US
Mailing Address - Phone:618-839-1572
Mailing Address - Fax:
Practice Address - Street 1:1900 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-5663
Practice Address - Country:US
Practice Address - Phone:812-316-1569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28189691A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse