Provider Demographics
NPI:1588082556
Name:MCCONAGHY, AMELIA MEAGAN (DO)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:MEAGAN
Last Name:MCCONAGHY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:BUTLER-NALIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:905 FRANKLIN ST.
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703
Mailing Address - Country:US
Mailing Address - Phone:503-221-0161
Mailing Address - Fax:
Practice Address - Street 1:905 FRANKLIN ST.
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703
Practice Address - Country:US
Practice Address - Phone:503-221-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-06
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO190748207Q00000X
OK5775207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty