Provider Demographics
NPI:1023675022
Name:TINLING, MEGAN ROCHELLE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ROCHELLE
Last Name:TINLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13234 SW PORTIA LN
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97224-3123
Mailing Address - Country:US
Mailing Address - Phone:503-869-8454
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200742768RN363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR200742768RNOtherNURSING LICENSE