Provider Demographics
NPI:1003584590
Name:MCLAUGHLIN, ROXANNE (APN)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:
Other - Last Name:BYRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:8940 N WOOD SAGE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-7822
Mailing Address - Country:US
Mailing Address - Phone:309-243-3000
Mailing Address - Fax:309-243-3063
Practice Address - Street 1:8940 N WOOD SAGE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-7822
Practice Address - Country:US
Practice Address - Phone:309-243-3000
Practice Address - Fax:309-243-3274
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023849363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner