Provider Demographics
NPI:1861724379
Name:ATKINSON, MEGAN LORRAINE (FNP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LORRAINE
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:MEGAN
Other - Middle Name:LORRAINE
Other - Last Name:SUTTERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7822 SALT SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-9610
Mailing Address - Country:US
Mailing Address - Phone:315-663-5215
Mailing Address - Fax:
Practice Address - Street 1:300 MERIDIAN CENTRE BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3981
Practice Address - Country:US
Practice Address - Phone:315-481-3427
Practice Address - Fax:585-463-3105
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2015-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY567348-1163W00000X
NYF337360363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03194612Medicaid
NYJ400083864Medicare PIN