Provider Demographics
NPI:1730257510
Name:MARKS, MEGAN REBECCA (FNP)
Entity type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:REBECCA
Last Name:MARKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:MEGAN
Other - Middle Name:REBECCA
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 S CENTRAL
Mailing Address - Street 2:STE 201
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501
Mailing Address - Country:US
Mailing Address - Phone:541-773-8285
Mailing Address - Fax:541-773-1634
Practice Address - Street 1:125 S CENTRAL
Practice Address - Street 2:STE 201
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501
Practice Address - Country:US
Practice Address - Phone:541-773-8285
Practice Address - Fax:541-773-1634
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000844Medicaid
OR000844Medicaid