MEDICARE: MEGAN ELLYCE DRALLE

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	172V00000X	Community Health Worker		WA

General Provider Information

NPI Number	:	1346676855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN ELLYCE DRALLE

Provider Business Mailing Address
First Line	:	13347 AUSTIN RD
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-8061
Country	:	US
Telephone Number	:	360-708-8436
Fax Number	:

Provider Business Practice Location Address
First Line	:	13347 AUSTIN RD
Second Line	:
City	:	MOUNT VERNON
State	:	WA
Zip	:	98273-8061
Country	:	US
Telephone Number	:	360-708-8436
Fax Number	:

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

Provider Enumeration Date	:	09/17/2013
Last Update Date	:	09/17/2013

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