1730257510 NPI number — MRS. MEGAN REBECCA MARKS FNP

Table of content: MRS. MEGAN REBECCA MARKS FNP (NPI 1730257510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730257510 NPI number — MRS. MEGAN REBECCA MARKS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARKS
Provider First Name:
MEGAN
Provider Middle Name:
REBECCA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROWN
Provider Other First Name:
MEGAN
Provider Other Middle Name:
REBECCA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730257510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 S CENTRAL
Provider Second Line Business Mailing Address:
STE 201
Provider Business Mailing Address City Name:
MEDFORD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-773-8285
Provider Business Mailing Address Fax Number:
541-773-1634

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 S CENTRAL
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
MEDFORD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-773-8285
Provider Business Practice Location Address Fax Number:
541-773-1634
Provider Enumeration Date:
12/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000844 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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