1356915599 NPI number — BRITTANY ANNE MCGILL APRN, CNP

Table of content: BRITTANY ANNE MCGILL APRN, CNP (NPI 1356915599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356915599 NPI number — BRITTANY ANNE MCGILL APRN, CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGILL
Provider First Name:
BRITTANY
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEARD
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356915599
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
133 SPINDER DR STE 4015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61611-0016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-308-5100
Provider Business Mailing Address Fax Number:
309-308-5102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 SPINDER DR STE 4015
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61611-0016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-308-5100
Provider Business Practice Location Address Fax Number:
309-308-5102
Provider Enumeration Date:
05/13/2021

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: 363LF0000X , with the licence number:  209023019 , 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)





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