Healthcare Provider Details

I. General information

NPI: 1659208908
Provider Name (Legal Business Name): MEGAN MORTENSEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EXPO PKWY
SACRAMENTO CA
95815-4230
US

IV. Provider business mailing address

2472 CELTIC DR
LINCOLN CA
95648-2901
US

V. Phone/Fax

Practice location:
  • Phone: 916-437-6400
  • Fax:
Mailing address:
  • Phone: 916-437-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number749168
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: