Provider Demographics
NPI:1598428872
Name:DUTTON, MEGAN (DNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DUTTON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:STAFFEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2196 WHITE BEAR AVE N # 1751
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2708
Mailing Address - Country:US
Mailing Address - Phone:651-704-0322
Mailing Address - Fax:
Practice Address - Street 1:2196 WHITE BEAR AVE N # 1751
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2708
Practice Address - Country:US
Practice Address - Phone:651-704-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-14
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2392402163W00000X
MN8556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse