Provider Demographics
NPI:1558183855
Name:BIRNEY, MEGAN LILLIAN JUSTESEN (NP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:LILLIAN JUSTESEN
Last Name:BIRNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:LILLIAN
Other - Last Name:JUSTESEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2810 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-7822
Mailing Address - Country:US
Mailing Address - Phone:904-233-7327
Mailing Address - Fax:
Practice Address - Street 1:2810 LAUREL LN
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-7822
Practice Address - Country:US
Practice Address - Phone:904-233-7327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61582102363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty