Individual
MEGAN LEE MACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, ATC
Contact information
Practice address
53880 CARMICHAEL DR, SOUTH BEND, IN 46635-1567
(574) 247-9441
Mailing address
3600 W BETHEL AVE, MUNCIE, IN 47304-5407
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
363A00000X
Physician Assistant
Primary
1003718A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10003718A
IPLA
IN
Enumeration date
06/07/2017
Last updated
09/05/2024
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