Healthcare Provider Details

I. General information

NPI: 1609173186
Provider Name (Legal Business Name): MEGAN LEIGH PEARLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2011
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12123 SW 69TH AVE
TIGARD OR
97223-8514
US

IV. Provider business mailing address

1498 SE TECH CENTER PL STE 240
VANCOUVER WA
98683-5508
US

V. Phone/Fax

Practice location:
  • Phone: 971-708-7600
  • Fax:
Mailing address:
  • Phone: 360-597-1313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA221798
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: