Provider Demographics
NPI:1952645392
Name:MONTY, MEGAN MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:MONTY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14230 SW TEAL BLVD
Mailing Address - Street 2:APT. 36B
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-9365
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4510 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0504
Practice Address - Country:US
Practice Address - Phone:503-644-1171
Practice Address - Fax:503-643-7443
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201242524RN163W00000X
OR201807062NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse