Individual
MEGAN LIN HEINECKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
2222 NW LOVEJOY ST, SUITE 622, PORTLAND, OR 97210-3033
(503) 229-8455
(503) 229-7028
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2651
WI
363AS0400X
Surgical Physician Assistant
Primary
PA164609
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2059843
—
WA
05
—
500662343
—
OR
Enumeration date
09/10/2010
Last updated
07/26/2016
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