Provider Demographics
NPI:1245797364
Name:NIEMIEC, MEGAN KATHLEEN (MSN, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:MEGAN
Middle Name:KATHLEEN
Last Name:NIEMIEC
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2845 N. SHERIDAN ROAD
Mailing Address - Street 2:SUITE 912
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657
Mailing Address - Country:US
Mailing Address - Phone:773-281-0046
Mailing Address - Fax:
Practice Address - Street 1:1870 SILVER CROSS BLVD STE 250
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-8647
Practice Address - Country:US
Practice Address - Phone:815-463-8989
Practice Address - Fax:815-463-8948
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.018853363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1245797364Medicaid