Provider Demographics
NPI:1487199535
Name:LANDECK, MEGAN (NP)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:
Last Name:LANDECK
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 240
Mailing Address - Street 2:
Mailing Address - City:POINT REYES STATION
Mailing Address - State:CA
Mailing Address - Zip Code:94956-0240
Mailing Address - Country:US
Mailing Address - Phone:415-663-1082
Mailing Address - Fax:415-663-9474
Practice Address - Street 1:11150 STATE ROUTE 1
Practice Address - Street 2:
Practice Address - City:POINT REYES STATION
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-663-1082
Practice Address - Fax:415-663-9474
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily