Provider Demographics
NPI:1407685019
Name:SREDL, MEGAN MARIE (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:SREDL
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4736 ROYAL TROON DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27604-5844
Mailing Address - Country:US
Mailing Address - Phone:408-833-8382
Mailing Address - Fax:
Practice Address - Street 1:2500 BLUE RIDGE RD STE 200D
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-7515
Practice Address - Country:US
Practice Address - Phone:919-784-2057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5020520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily