MEDICARE: MEGAN POULSEN PA

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	363A00000X	Physician Assistant	64151	CA

General Provider Information

NPI Number	:	1316668551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN POULSEN PA

Provider Business Mailing Address
First Line	:	1381 UNIVERSITY ST
Second Line	:
City	:	HEALDSBURG
State	:	CA
Zip	:	95448-3314
Country	:	US
Telephone Number	:	707-433-5494
Fax Number	:

Provider Business Practice Location Address
First Line	:	8465 OLD REDWOOD HWY STE 320
Second Line	:
City	:	WINDSOR
State	:	CA
Zip	:	95492-9244
Country	:	US
Telephone Number	:	707-431-1170
Fax Number	:	707-837-0129

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

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/11/2024

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Directions to “ MEGAN POULSEN PA” Practice Location

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