Healthcare Provider Details

I. General information

NPI: 1952715625
Provider Name (Legal Business Name): MEAGAN SINA ELISE PETERSEN CNM, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEAGAN SINA PETERSEN CNM, DNP

II. Dates (important events)

Enumeration Date: 06/20/2014
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR 9040 JACKSON AVE
TACOMA WA
98431-0001
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-1338
  • Fax:
Mailing address:
  • Phone: 510-205-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60610408
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: