Provider Demographics
NPI:1235673666
Name:THREM, MEGAN (APN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:THREM
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 FRANKLIN AVE COMMUNITY HEALTH CARE CLINIC
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761
Mailing Address - Country:US
Mailing Address - Phone:309-888-5531
Mailing Address - Fax:309-888-5530
Practice Address - Street 1:900 FRANKLIN AVE COMMUNITY HEALTH CARE CLINIC
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-888-5531
Practice Address - Fax:309-888-5530
Is Sole Proprietor?:No
Enumeration Date:2016-12-04
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.392906163W00000X
IL209.015473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse