Provider Demographics
NPI:1700471125
Name:TERWILLIGER, MEGAN MICHELLE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MICHELLE
Last Name:TERWILLIGER
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 1:34 BEEKMAN DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-5252
Mailing Address - Country:US
Mailing Address - Phone:845-416-7077
Mailing Address - Fax:
Practice Address - Street 1:34 BEEKMAN DR
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-5252
Practice Address - Country:US
Practice Address - Phone:845-416-7077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY308480164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY308480Medicaid