Provider Demographics
NPI:1053796714
Name:FARRIS, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GIBSON DR
Mailing Address - Street 2:APT 1912
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5400
Mailing Address - Country:US
Mailing Address - Phone:804-349-6347
Mailing Address - Fax:
Practice Address - Street 1:8207 SIERRA COLLEGE BLVD
Practice Address - Street 2:SUITE 510
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-9407
Practice Address - Country:US
Practice Address - Phone:804-349-6347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program