Healthcare Provider Details

I. General information

NPI: 1104422930
Provider Name (Legal Business Name): MEGAN NICOLE SCHAUWECKER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4060 FAIRMOUNT AVE
SAN DIEGO CA
92105-1608
US

IV. Provider business mailing address

4157 FAIRMOUNT AVE
SAN DIEGO CA
92105-1609
US

V. Phone/Fax

Practice location:
  • Phone: 619-280-4213
  • Fax: 619-564-8140
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95031515
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95197861
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: