Provider Demographics
NPI:1972223022
Name:SOULIGNE, MEGAN L (NP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:L
Last Name:SOULIGNE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:L
Other - Last Name:HAAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 N 300 W
Mailing Address - Street 2:
Mailing Address - City:WEST LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47906-9653
Mailing Address - Country:US
Mailing Address - Phone:765-337-5630
Mailing Address - Fax:
Practice Address - Street 1:8000 N 300 W
Practice Address - Street 2:
Practice Address - City:WEST LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47906-9653
Practice Address - Country:US
Practice Address - Phone:765-337-5630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28252203A163W00000X
IN71014441A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300083322Medicaid