Healthcare Provider Details

I. General information

NPI: 1184805129
Provider Name (Legal Business Name): MEGAN ADELE BEDDOW PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W 17TH ST
SANTA ANA CA
92706-2316
US

IV. Provider business mailing address

285 N SINGINGWOOD ST UNIT 16
ORANGE CA
92869-5708
US

V. Phone/Fax

Practice location:
  • Phone: 714-347-0393
  • Fax:
Mailing address:
  • Phone: 714-876-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number659844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: