Provider Demographics
NPI:1821312489
Name:ANDERSON, MEGAN JARDINA (APN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:JARDINA
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 LINDEN ST STE 222
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2424
Mailing Address - Country:US
Mailing Address - Phone:773-383-2392
Mailing Address - Fax:
Practice Address - Street 1:242 LINDEN ST STE 222
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2424
Practice Address - Country:US
Practice Address - Phone:773-383-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-24
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007768363LW0102X
CA95018249363LW0102X
CO10285363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO45173061Medicaid