Healthcare Provider Details

I. General information

NPI: 1821312489
Provider Name (Legal Business Name): MEGAN JARDINA ANDERSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2010
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 LINDEN ST STE 222
FORT COLLINS CO
80524-2424
US

IV. Provider business mailing address

242 LINDEN ST STE 222
FORT COLLINS CO
80524-2424
US

V. Phone/Fax

Practice location:
  • Phone: 773-383-2392
  • Fax:
Mailing address:
  • Phone: 773-383-2392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209007768
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number95018249
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number10285
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: