Provider Demographics
NPI:1548863830
Name:VANLISHOUT, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:VANLISHOUT
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 1:108 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:MOTT
Mailing Address - State:ND
Mailing Address - Zip Code:58646-7102
Mailing Address - Country:US
Mailing Address - Phone:701-260-1430
Mailing Address - Fax:
Practice Address - Street 1:108 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:MOTT
Practice Address - State:ND
Practice Address - Zip Code:58646-7102
Practice Address - Country:US
Practice Address - Phone:701-260-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide