Provider Demographics
NPI:1730206558
Name:NELLES-DALSTROM, MEGHANN ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:MEGHANN
Middle Name:ELIZABETH
Last Name:NELLES-DALSTROM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MEGHANN
Other - Middle Name:ELIZABETH
Other - Last Name:NELLES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4011 TALBOT RD S STE 430
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5791
Mailing Address - Country:US
Mailing Address - Phone:425-690-3498
Mailing Address - Fax:425-690-9498
Practice Address - Street 1:4011 TALBOT RD S STE 430
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5791
Practice Address - Country:US
Practice Address - Phone:425-690-3498
Practice Address - Fax:425-690-9498
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.009514208600000X
WAMD614271662086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery