Provider Demographics
NPI:1679451322
Name:POWELL, MEGAN CASSIDY (BSN, RN, CNRN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:CASSIDY
Last Name:POWELL
Suffix:
Gender:F
Credentials:BSN, RN, CNRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OAK GROVE AVE UNIT 215
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-6118
Mailing Address - Country:US
Mailing Address - Phone:770-634-2444
Mailing Address - Fax:
Practice Address - Street 1:55 FRUIT ST WANG 835
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-7565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00398817163WN0800X
MARN2382739163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WN0800XNursing Service ProvidersRegistered NurseNeuroscience