Provider Demographics
NPI:1043567514
Name:MENKEN, MEAGAN SUE (ARNP)
Entity Type:Individual
Prefix:
First Name:MEAGAN
Middle Name:SUE
Last Name:MENKEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:220 SOUTHBROOKE DRIVE
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-0658
Mailing Address - Country:US
Mailing Address - Phone:319-236-7720
Mailing Address - Fax:319-236-7739
Practice Address - Street 1:220 SOUTHBROOKE DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5802
Practice Address - Country:US
Practice Address - Phone:319-236-7720
Practice Address - Fax:319-236-7739
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA-122144363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily