Provider Demographics
NPI:1770051740
Name:ANDERSON, MEGGAN (APRN-C)
Entity type:Individual
Prefix:
First Name:MEGGAN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATTN: CREDENTIALING
Mailing Address - Street 2:1400 E. KINCAID STREET
Mailing Address - City:MT. VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-4127
Mailing Address - Country:US
Mailing Address - Phone:360-814-6724
Mailing Address - Fax:360-428-6485
Practice Address - Street 1:405 W STANLEY ST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252-8631
Practice Address - Country:US
Practice Address - Phone:360-691-2419
Practice Address - Fax:360-691-0489
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60910466363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2113234Medicaid
WA400206OtherLABOR & INDUSTRIES