Provider Demographics
NPI:1861934135
Name:DE LUCA, MEGHAN
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:DE LUCA
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 1:6002 WESTGATE BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-2572
Mailing Address - Country:US
Mailing Address - Phone:253-761-2244
Mailing Address - Fax:360-744-6270
Practice Address - Street 1:6002 WESTGATE BLVD STE 230
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98406-2572
Practice Address - Country:US
Practice Address - Phone:253-761-2244
Practice Address - Fax:360-744-6270
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60702848367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2072472Medicaid