Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | MD60170077 | WA |
N | 2080A0000X | Adolescent Medicine | MD60170077 | WA |
NPI | 1225343932 |
---|---|
Provider Name | Megan Alysa Beaumont |
First Address | Everett, WA 98206-5127 |
Second Address | Mukilteo, WA 98275-4711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2010 |
Last Update Date | 03/06/2019 |