Provider Demographics
NPI:1619267358
Name:GRANDE, MEGAN C (PA)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:GRANDE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 19387
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33318-0387
Mailing Address - Country:US
Mailing Address - Phone:877-693-5700
Mailing Address - Fax:954-625-6034
Practice Address - Street 1:1409 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:N LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7120
Practice Address - Country:US
Practice Address - Phone:702-657-5512
Practice Address - Fax:702-649-2300
Is Sole Proprietor?:No
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA1253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant