Basic Information
| Provider Information | |||||||||
| NPI: | 1770051740 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDERSON | ||||||||
| FirstName: | MEGGAN | ||||||||
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| Credential: | APRN-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | ATTN: CREDENTIALING | ||||||||
| Address2: | 1400 E. KINCAID STREET | ||||||||
| City: | MT. VERNON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982744127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3608146724 | ||||||||
| FaxNumber: | 3604286485 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 W STANLEY ST | ||||||||
| Address2: | |||||||||
| City: | GRANITE FALLS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982528631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606912419 | ||||||||
| FaxNumber: | 3606910489 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2018 | ||||||||
| LastUpdateDate: | 10/22/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP60910466 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 2113234 | 05 | WA | MEDICAID | 400206 | 01 | WA | LABOR & INDUSTRIES | OTHER |