Provider Demographics
NPI:1992704720
Name:MEEHAN, MARY L (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:L
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:DEBRUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1183 MONROE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1662
Mailing Address - Country:US
Mailing Address - Phone:585-256-7802
Mailing Address - Fax:585-256-7793
Practice Address - Street 1:1183 MONROE AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1662
Practice Address - Country:US
Practice Address - Phone:585-256-7802
Practice Address - Fax:585-256-7793
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333826-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily