Provider Demographics
NPI:1528442977
Name:ANDERSON, MEGAN L (FNP)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33562 YUCAIPA BLVD # 4-413
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2072
Mailing Address - Country:US
Mailing Address - Phone:909-725-0669
Mailing Address - Fax:
Practice Address - Street 1:222 E OLIVE AVE STE 5
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5268
Practice Address - Country:US
Practice Address - Phone:909-283-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95002709363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily