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General NPI Number Information
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NPI Number | 1417765579
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Entity Type | Individual
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Provider Name | MEGAN ANDERSON NUTRITIONIST
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Gender | Female
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Dates
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Enumeration Date | 12/20/2024
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Last Update Date | 12/20/2024
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Provider Practice Location Address
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Address Line | 5000 E SHENNUM DR # 1
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City | WASILLA
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State | AK
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Zip | 99654-7718
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Country | US
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Telephone | 907-373-3420
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Fax |
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Provider Business Mailing Address
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Address Line | 760 N GULKANA CT
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City | PALMER
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State | AK
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Zip | 99645-6156
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Country | US
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Telephone | 715-797-7187
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Fax |
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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 | 133N00000X
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Taxonomy Name | Nutritionist
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License Number | 233304
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License Number State | AK
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