Provider Demographics
NPI:1396997292
Name:HARLESS, MEGAN LOUISE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:LOUISE
Last Name:HARLESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LOUISE
Other - Last Name:SURATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:308 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-1881
Mailing Address - Country:US
Mailing Address - Phone:503-538-9431
Mailing Address - Fax:503-538-2358
Practice Address - Street 1:308 VILLA RD
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-1881
Practice Address - Country:US
Practice Address - Phone:503-538-9431
Practice Address - Fax:503-538-2358
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA1404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant