Provider Demographics
NPI:1073840799
Name:MEANEY, MICHAEL PATRICK (APRN, CNP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PATRICK
Last Name:MEANEY
Suffix:
Gender:M
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 W ALTORFER DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1807
Mailing Address - Country:US
Mailing Address - Phone:309-370-9323
Mailing Address - Fax:309-683-7752
Practice Address - Street 1:2265 W ALTORFER DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1807
Practice Address - Country:US
Practice Address - Phone:309-683-7700
Practice Address - Fax:309-683-7752
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007899363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology