Provider Demographics
NPI:1194158238
Name:NAUGHTON, MIRJAM J (APN)
Entity type:Individual
Prefix:
First Name:MIRJAM
Middle Name:J
Last Name:NAUGHTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MIRJAM
Other - Middle Name:J
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:101 E PLUMMER BLVD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8047
Mailing Address - Country:US
Mailing Address - Phone:217-588-2600
Mailing Address - Fax:
Practice Address - Street 1:101 E PLUMMER BLVD
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8047
Practice Address - Country:US
Practice Address - Phone:217-588-2600
Practice Address - Fax:217-862-0202
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010635363LF0000X
IL277.000330363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.362673OtherRN LICENSE