Provider Demographics
NPI:1720730393
Name:DAMICO, MEGAN GALLEGOS (RN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:GALLEGOS
Last Name:DAMICO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:GALLEGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1902 NW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-8296
Mailing Address - Country:US
Mailing Address - Phone:360-947-7252
Mailing Address - Fax:
Practice Address - Street 1:1902 NW 26TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-8296
Practice Address - Country:US
Practice Address - Phone:360-947-7252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60311875163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse