Provider Demographics
NPI:1316716657
Name:LAWRENCE, MEAGHAN NICOLL (PA)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:NICOLL
Last Name:LAWRENCE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:90 DOCTOR TINKER ST
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-9396
Mailing Address - Country:US
Mailing Address - Phone:802-888-8405
Mailing Address - Fax:802-888-8406
Practice Address - Street 1:90 DOCTOR TINKER ST
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-9396
Practice Address - Country:US
Practice Address - Phone:802-888-8405
Practice Address - Fax:802-888-8406
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550031819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant