Provider Demographics
NPI:1346676855
Name:DRALLE, MEGAN ELLYCE
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELLYCE
Last Name:DRALLE
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 1:13347 AUSTIN RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-8061
Mailing Address - Country:US
Mailing Address - Phone:360-708-8436
Mailing Address - Fax:
Practice Address - Street 1:13347 AUSTIN RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-8061
Practice Address - Country:US
Practice Address - Phone:360-708-8436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker