Healthcare Provider Details

I. General information

NPI: 1972130847
Provider Name (Legal Business Name): MEGAN DANIELLE ANTHONY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 N CEDAR AVE STE 1
OWATONNA MN
55060-2306
US

IV. Provider business mailing address

411 WALNUT ST # 23368
GREEN COVE SPRINGS FL
32043-3443
US

V. Phone/Fax

Practice location:
  • Phone: 360-375-2240
  • Fax: 800-861-4954
Mailing address:
  • Phone: 360-375-2240
  • Fax: 800-861-4954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO215226
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO.OP.70146055
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number83191
License Number StateMN
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number236757
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: