Provider Demographics
NPI:1083086573
Name:DEVLIN, MEGHAN LEA (ARNP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:LEA
Last Name:DEVLIN
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 1:17707 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-1967
Mailing Address - Country:US
Mailing Address - Phone:360-282-3889
Mailing Address - Fax:
Practice Address - Street 1:17707 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1967
Practice Address - Country:US
Practice Address - Phone:360-282-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-23
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60472047163W00000X
CA95053615163W00000X
WAAP60594373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse