Provider Demographics
NPI:1881826394
Name:MEENAGHAN, MATIJA ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MATIJA
Middle Name:ELIZABETH
Last Name:MEENAGHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 SADLER WAY
Mailing Address - Street 2:STE. 101
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4609
Mailing Address - Country:US
Mailing Address - Phone:907-374-7744
Mailing Address - Fax:
Practice Address - Street 1:1275 SADLER WAY
Practice Address - Street 2:STE. 101
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3175
Practice Address - Country:US
Practice Address - Phone:907-374-7911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-17
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK498111N00000X
AK2390363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No111N00000XChiropractic ProvidersChiropractor