Provider Demographics
NPI:1316496144
Name:BERGERON, MEGHAN YOUNG (ARNP)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:YOUNG
Last Name:BERGERON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:SUZANNE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 12TH AVE S
Mailing Address - Street 2:SUITE 901
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2712
Mailing Address - Country:US
Mailing Address - Phone:206-548-3114
Mailing Address - Fax:206-762-6355
Practice Address - Street 1:10030 SW 210TH ST
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6584
Practice Address - Country:US
Practice Address - Phone:206-463-3671
Practice Address - Fax:206-463-3613
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP 60689549363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily