Healthcare Provider Details

I. General information

NPI: 1730206558
Provider Name (Legal Business Name): MEGHANN ELIZABETH NELLES-DALSTROM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGHANN ELIZABETH NELLES M.D.

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 TALBOT RD S STE 430
RENTON WA
98055-5791
US

IV. Provider business mailing address

4011 TALBOT RD S STE 430
RENTON WA
98055-5791
US

V. Phone/Fax

Practice location:
  • Phone: 425-690-3498
  • Fax: 425-690-9498
Mailing address:
  • Phone: 425-690-3498
  • Fax: 425-690-9498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD61427166
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number57.009514
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: