Provider Demographics
NPI:1699158857
Name:GREGG, MEEGAN RYAN (NP)
Entity type:Individual
Prefix:
First Name:MEEGAN
Middle Name:RYAN
Last Name:GREGG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611A BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5303
Mailing Address - Country:US
Mailing Address - Phone:831-277-9759
Mailing Address - Fax:
Practice Address - Street 1:940 DISC DR
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-4544
Practice Address - Country:US
Practice Address - Phone:831-430-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA783783163WC0400X
CA22176363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163WC0400XNursing Service ProvidersRegistered NurseCase Management