Healthcare Provider Details

I. General information

NPI: 1063888170
Provider Name (Legal Business Name): MEGAN ADELE HAUGEN RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MEGAN ADELE REARDON

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4465 CORDATA PKWY SUITE B
BELLINGHAM WA
98226-8037
US

IV. Provider business mailing address

1115 SE 164TH AVE DEPT 358
VANCOUVER WA
98683-9324
US

V. Phone/Fax

Practice location:
  • Phone: 360-752-5601
  • Fax: 360-752-5667
Mailing address:
  • Phone: 360-752-5601
  • Fax: 360-752-5667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86037415
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI60596590
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: