Individual
MEAGAN HANEY FAZEKAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
122 SACCAPATOY DR, MONTGOMERY, AL 36117-4122
(334) 868-1017
Mailing address
122 SACCAPATOY DR, MONTGOMERY, AL 36117-4122
(334) 868-1017
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1-148540
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NONE
NONE
AL
Enumeration date
04/20/2021
Last updated
11/15/2023
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