Provider Demographics
NPI:1134469687
Name:SHIRLEY, MEGAN E GANONG (PA-C, MPA)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:E GANONG
Last Name:SHIRLEY
Suffix:
Gender:F
Credentials:PA-C, MPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10956 DONNER PASS RD STE 230
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-4862
Mailing Address - Country:US
Mailing Address - Phone:530-582-3277
Mailing Address - Fax:530-550-6722
Practice Address - Street 1:10956 DONNER PASS RD STE 230
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-4862
Practice Address - Country:US
Practice Address - Phone:530-582-3277
Practice Address - Fax:530-550-6722
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22841363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22841OtherPA-C LICENSE