Provider Demographics
NPI:1720895659
Name:MASSEY, MEGAN MONELL
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MONELL
Last Name:MASSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 LARKSPUR DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4507
Mailing Address - Country:US
Mailing Address - Phone:308-631-0716
Mailing Address - Fax:
Practice Address - Street 1:2350 FIVE ROCKS RD
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-6401
Practice Address - Country:US
Practice Address - Phone:308-631-9871
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-13
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion