Healthcare Provider Details

I. General information

NPI: 1174024277
Provider Name (Legal Business Name): MEGAN WURTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN SHEWMAKER

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2313 I ST EUREKA
EUREKA CA
95501-3323
US

IV. Provider business mailing address

2313 I ST EUREKA
EUREKA CA
95501-3323
US

V. Phone/Fax

Practice location:
  • Phone: 707-572-5324
  • Fax:
Mailing address:
  • Phone: 707-572-5324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number88536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: