Provider Demographics
NPI:1285983825
Name:CASEY, MEGAN JEAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JEAN
Last Name:CASEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:579 CORONA RD
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954-1418
Mailing Address - Country:US
Mailing Address - Phone:415-717-1474
Mailing Address - Fax:
Practice Address - Street 1:2261 ELM ST
Practice Address - Street 2:NAPA COUNTY HEALTH AND HUMAN SERVICES AGENCY
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3721
Practice Address - Country:US
Practice Address - Phone:707-253-4567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program