MEDICARE: MONIQUEA JEAN DEGAN

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	363LF0000X	Family Nurse Practitioner	AP60712418	WA
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	200250091NP	OR
3	363LF0000X	Family Nurse Practitioner	200650091 NP	OR
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60712418	WA

General Provider Information

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

Provider Business Mailing Address
First Line	:	4036 E BURNSIDE ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97214-2024
Country	:	US
Telephone Number	:	503-799-9623
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 POLK ST 4B
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368
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	:	02/04/2026

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Directions to “ MONIQUEA JEAN DEGAN ” Practice Location

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