Healthcare Provider Details

I. General information

NPI: 1609421312
Provider Name (Legal Business Name): RAISSA MEEGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2019
Last Update Date: 12/21/2024
Certification Date: 12/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 S PLUM ST STE A
SEATTLE WA
98144-4539
US

IV. Provider business mailing address

2120 S PLUM ST STE A
SEATTLE WA
98144-4539
US

V. Phone/Fax

Practice location:
  • Phone: 206-441-3043
  • Fax: 206-441-3014
Mailing address:
  • Phone: 206-441-3043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61323272
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number60967475
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: