Provider Demographics
NPI:1104184555
Name:CONCA, MEGAN LM
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LM
Last Name:CONCA
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 1:1030 NW BUCHANAN AVE
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-6043
Mailing Address - Country:US
Mailing Address - Phone:541-738-6193
Mailing Address - Fax:
Practice Address - Street 1:1030 NW BUCHANAN AVE
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-6043
Practice Address - Country:US
Practice Address - Phone:541-738-6193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula