Provider Demographics
NPI:1306337647
Name:BURNS, MEGAN ELLEN (LAC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELLEN
Last Name:BURNS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19317 SE 9TH CIR
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-7257
Mailing Address - Country:US
Mailing Address - Phone:828-989-9229
Mailing Address - Fax:
Practice Address - Street 1:800 FRANKLIN ST STE 200
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3356
Practice Address - Country:US
Practice Address - Phone:828-989-9229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60836118171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist