Healthcare Provider Details

I. General information

NPI: 1457983801
Provider Name (Legal Business Name): MEGAN FULTON CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UPPER RAGSDALE DR
MONTEREY CA
93940-7849
US

IV. Provider business mailing address

416B MAIN ST
SALINAS CA
93901-3306
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-3577
  • Fax:
Mailing address:
  • Phone: 831-800-7887
  • Fax: 831-998-7155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberNA95001242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: