Provider Demographics
NPI:1598505331
Name:DAVIS, MEGAN ERIN (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ERIN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 75TH ST. 1ST FLOOR
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-2700
Mailing Address - Country:US
Mailing Address - Phone:630-646-7000
Mailing Address - Fax:630-548-1563
Practice Address - Street 1:3329 75TH ST. 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517-2700
Practice Address - Country:US
Practice Address - Phone:630-646-7000
Practice Address - Fax:630-548-1563
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085010481363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant