MEDICARE: MONIQUEA JEAN DEGAN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60712418	WA
2	363LF0000X	Family Nurse Practitioner	200650091 NP	OR
3	363LF0000X	Family Nurse Practitioner	AP60712418	WA
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	200250091NP	OR

General Provider Information

NPI Number	:	1205933884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUEA JEAN DEGAN APRN

Provider Business Mailing Address
First Line	:	210 POLK ST STE 4B
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6739
Country	:	US
Telephone Number	:	360-390-2701
Fax Number	:	360-344-5045

Provider Business Practice Location Address
First Line	:	210 POLK ST STE 4B
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6739
Country	:	US
Telephone Number	:	360-390-2701
Fax Number	:	360-443-5045

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	03/18/2026

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