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Individual

MEGAN BROOKE WALRAVEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
9427 SW BARNES RD STE 495, PORTLAND, OR 97225-6612
(503) 962-1000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA152810
OR
363AS0400X
Surgical Physician Assistant
PA152810
OR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1972812261
WA
05
500626433
OR
Enumeration date
10/04/2010
Last updated
04/15/2024
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