Provider Demographics
NPI:1316668551
Name:POULSEN, MEGAN (PA)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:POULSEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1381 UNIVERSITY ST
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-3314
Mailing Address - Country:US
Mailing Address - Phone:707-433-5494
Mailing Address - Fax:
Practice Address - Street 1:8465 OLD REDWOOD HWY STE 320
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9244
Practice Address - Country:US
Practice Address - Phone:707-431-1170
Practice Address - Fax:707-837-0129
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA64151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant