Provider Demographics
NPI:1982477402
Name:PURVES, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:PURVES
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 1:1306 KELCRASTA DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-8263
Mailing Address - Country:US
Mailing Address - Phone:989-640-5791
Mailing Address - Fax:
Practice Address - Street 1:308 W CIRCLE DR
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-3700
Practice Address - Country:US
Practice Address - Phone:989-640-5791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program