Provider Demographics
NPI:1245828854
Name:PRATT, MEGAN ILENE (CPM,LDM)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:ILENE
Last Name:PRATT
Suffix:
Gender:F
Credentials:CPM,LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 AMBER LN
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-9501
Mailing Address - Country:US
Mailing Address - Phone:541-218-9808
Mailing Address - Fax:
Practice Address - Street 1:1453 REDWOOD CIR
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5523
Practice Address - Country:US
Practice Address - Phone:541-916-8333
Practice Address - Fax:541-843-1010
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10212174176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife