Healthcare Provider Details

I. General information

NPI: 1770051740
Provider Name (Legal Business Name): MEGGAN ANDERSON APRN-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2018
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W STANLEY ST
GRANITE FALLS WA
98252-8631
US

IV. Provider business mailing address

ATTN: CREDENTIALING 1400 E. KINCAID STREET
MT. VERNON WA
98274-4127
US

V. Phone/Fax

Practice location:
  • Phone: 360-691-2419
  • Fax: 360-691-0489
Mailing address:
  • Phone: 360-814-6724
  • Fax: 360-428-6485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60910466
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: