Provider Demographics
NPI:1427339803
Name:MATIASEK, MEGAN (PNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:MATIASEK
Suffix:
Gender:F
Credentials:PNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 NORTH MARSHFIELD AVE
Mailing Address - Street 2:BASEMENT APARTMENT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2994
Mailing Address - Country:US
Mailing Address - Phone:617-549-1822
Mailing Address - Fax:
Practice Address - Street 1:225 EAST CHICAGO AVE
Practice Address - Street 2:BOX 22
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5724
Practice Address - Country:US
Practice Address - Phone:312-227-4240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN267846363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics