Provider Demographics
NPI:1578348421
Name:ANDERSEN, MEGAN EMILY
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:EMILY
Last Name:ANDERSEN
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 1:9325 N FARM ROAD 75
Mailing Address - Street 2:
Mailing Address - City:WALNUT GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65770-2871
Mailing Address - Country:US
Mailing Address - Phone:417-300-5194
Mailing Address - Fax:
Practice Address - Street 1:9325 N FARM ROAD 75
Practice Address - Street 2:
Practice Address - City:WALNUT GROVE
Practice Address - State:MO
Practice Address - Zip Code:65770-2871
Practice Address - Country:US
Practice Address - Phone:417-300-5194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program