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General NPI Number Information
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NPI Number | 1245547330
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Entity Type | Individual
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Provider Name | MEGAN LIN HEINECKE PAC
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Gender | Female
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 07/26/2016
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Provider Practice Location Address
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Address Line | 2222 NW LOVEJOY ST SUITE 622
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City | PORTLAND
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State | OR
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Zip | 97210-3033
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Country | US
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Telephone | 503-229-8455
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Fax | 503-229-7028
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Provider Business Mailing Address
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Address Line | 847 NE 19TH AVE SUITE 300
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City | PORTLAND
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State | OR
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Zip | 97232-2684
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Country | US
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Telephone | 503-963-2801
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Fax | 503-963-2825
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA164609
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2651
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License Number State | WI
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