Healthcare Provider Details

I. General information

NPI: 1528439528
Provider Name (Legal Business Name): MEGAN DEMERICH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 SE DIVISION ST STE 203
PORTLAND OR
97266-1354
US

IV. Provider business mailing address

10011 SE DIVISION ST STE 203
PORTLAND OR
97266-1354
US

V. Phone/Fax

Practice location:
  • Phone: 503-255-2343
  • Fax:
Mailing address:
  • Phone: 503-255-2343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP9335782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: