Basic Information
Provider Information | |||||||||
NPI: | 1609155548 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCFARLAND | ||||||||
FirstName: | MEAGAN | ||||||||
MiddleName: | HELEN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MACLENNAN | ||||||||
OtherFirstName: | MEAGAN | ||||||||
OtherMiddleName: | HELEN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 6149 | ||||||||
Address2: |   | ||||||||
City: | ALOHA | ||||||||
State: | OR | ||||||||
PostalCode: | 970070149 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5033528657 | ||||||||
FaxNumber: | 5033528658 | ||||||||
Practice Location | |||||||||
Address1: | 5100 SW MACADAM AVE | ||||||||
Address2: | SUITE 200 | ||||||||
City: | PORTLAND | ||||||||
State: | OR | ||||||||
PostalCode: | 972396102 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9712025500 | ||||||||
FaxNumber: | 9712025555 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/09/2011 | ||||||||
LastUpdateDate: | 03/17/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/17/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 201150099NP | OR | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 500638273 | 05 | OR |   | MEDICAID |