MEDICARE: MEGAN TITCOMB CD, CH

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	374J00000X	Doula
2	175F00000X	Naturopath

General Provider Information

NPI Number	:	1962739151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN TITCOMB CD, CH

Provider Business Mailing Address
First Line	:	2987 FRANK ST
Second Line	:
City	:	MAPLEWOOD
State	:	MN
Zip	:	55109-1092
Country	:	US
Telephone Number	:	651-398-0817
Fax Number	:

Provider Business Practice Location Address
First Line	:	4120 LEXINGTON WAY
Second Line	:	SUITE 150
City	:	EAGAN
State	:	MN
Zip	:	55123-1512
Country	:	US
Telephone Number	:	651-398-0817
Fax Number	:

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

Provider Enumeration Date	:	11/09/2009
Last Update Date	:	11/30/2010

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