Provider Demographics
NPI:1215362561
Name:SUWARA, MEGAN KELLIE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:KELLIE
Last Name:SUWARA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:KELLIE
Other - Last Name:MCCULLOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:45300 PORTOLA AVE UNIT 2192
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92261-7089
Mailing Address - Country:US
Mailing Address - Phone:760-398-3555
Mailing Address - Fax:
Practice Address - Street 1:49617 CESAR CHAVEZ ST STE B
Practice Address - Street 2:
Practice Address - City:COACHELLA
Practice Address - State:CA
Practice Address - Zip Code:92236-1535
Practice Address - Country:US
Practice Address - Phone:760-398-3555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23608363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily