Provider Demographics
NPI:1104593995
Name:NEPHEW, MEGAN ANN (BSN, RN, CDP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:NEPHEW
Suffix:
Gender:F
Credentials:BSN, RN, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DANFORTH
Mailing Address - State:IL
Mailing Address - Zip Code:60930-5800
Mailing Address - Country:US
Mailing Address - Phone:815-269-2970
Mailing Address - Fax:815-269-2094
Practice Address - Street 1:403 N 4TH ST
Practice Address - Street 2:
Practice Address - City:DANFORTH
Practice Address - State:IL
Practice Address - Zip Code:60930-5800
Practice Address - Country:US
Practice Address - Phone:815-269-2970
Practice Address - Fax:815-269-2094
Is Sole Proprietor?:No
Enumeration Date:2021-08-27
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041413197163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse