Provider Demographics
NPI:1700457249
Name:TAPPE, MEGAN KATHLEEN
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:TAPPE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4040 COON RAPIDS BLVD NW STE 120
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-4568
Mailing Address - Country:US
Mailing Address - Phone:763-427-9980
Mailing Address - Fax:763-427-0904
Practice Address - Street 1:4040 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-4567
Practice Address - Country:US
Practice Address - Phone:763-427-9980
Practice Address - Fax:763-427-0904
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN13763363A00000X
MN1169835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant