Provider Demographics
NPI:1972354033
Name:DE ROO, MEGAN
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:DE ROO
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 1:3329 BERKSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-8920
Mailing Address - Country:US
Mailing Address - Phone:615-410-8442
Mailing Address - Fax:
Practice Address - Street 1:2 PROFESSIONAL PARK DR STE 21
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6584
Practice Address - Country:US
Practice Address - Phone:423-379-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program