Provider Demographics
NPI:1538803135
Name:LINEHAN, MEGHAN (RN)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:LINEHAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:LINEHAN
Other - Last Name:PACKARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:10614 ALISON DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2240
Mailing Address - Country:US
Mailing Address - Phone:703-408-4208
Mailing Address - Fax:
Practice Address - Street 1:10614 ALISON DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2240
Practice Address - Country:US
Practice Address - Phone:703-408-4208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-21
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001264315163W00000X
VA0024184485363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse