Provider Demographics
NPI:1275257438
Name:MEYNIG, KATRINA SUZANNE (NP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:SUZANNE
Last Name:MEYNIG
Suffix:
Gender:F
Credentials:NP
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 6295
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97708-6295
Mailing Address - Country:US
Mailing Address - Phone:530-919-1030
Mailing Address - Fax:
Practice Address - Street 1:3920 E ASHWOOD RD
Practice Address - Street 2:
Practice Address - City:MADRAS
Practice Address - State:OR
Practice Address - Zip Code:97741-9703
Practice Address - Country:US
Practice Address - Phone:541-325-5999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-30
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95019297363LF0000X
OR202200909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily