Provider Demographics
NPI:1588816102
Name:NIGHTINGALE, MEGAN K (AUD)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:K
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19319 7TH AVENUE SUITE 102
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370
Mailing Address - Country:US
Mailing Address - Phone:360-697-3061
Mailing Address - Fax:360-697-2116
Practice Address - Street 1:19319 7TH AVENUE SUITE 102
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370
Practice Address - Country:US
Practice Address - Phone:360-697-3061
Practice Address - Fax:360-697-2116
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD000D1394231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9260019OtherMEDICAID HAS
WA7120413Medicaid
WA73468OtherL & I
WA1107102OtherCHPW
192493100OtherUS DOL
WA7120413Medicaid