1245797364 NPI number — MS. MEGAN KATHLEEN NIEMIEC MSN, FNP-BC

Table of content: MS. MEGAN KATHLEEN NIEMIEC MSN, FNP-BC (NPI 1245797364)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245797364 NPI number — MS. MEGAN KATHLEEN NIEMIEC MSN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIEMIEC
Provider First Name:
MEGAN
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245797364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/05/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2845 N. SHERIDAN ROAD
Provider Second Line Business Mailing Address:
SUITE 912
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-281-0046
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1870 SILVER CROSS BLVD STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW LENOX
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60451-8647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-463-8989
Provider Business Practice Location Address Fax Number:
815-463-8948
Provider Enumeration Date:
02/25/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP2300X , with the licence number:  209.018853 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1245797364 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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