Provider Demographics
NPI:1992492805
Name:BEAUDIN, MEGAN JOY (APRN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JOY
Last Name:BEAUDIN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JOY
Other - Last Name:BREUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83869-0937
Mailing Address - Country:US
Mailing Address - Phone:253-777-7944
Mailing Address - Fax:
Practice Address - Street 1:547 KRUPP RD
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:ID
Practice Address - Zip Code:83869-0937
Practice Address - Country:US
Practice Address - Phone:253-777-7944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID62410363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily