Provider Demographics
NPI:1265680219
Name:CHACKO, MEENA S (APN NP-C)
Entity Type:Individual
Prefix:MS
First Name:MEENA
Middle Name:S
Last Name:CHACKO
Suffix:
Gender:F
Credentials:APN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6678 MAJESTIC WAY
Mailing Address - Street 2:
Mailing Address - City:CARPENTERSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60110-3441
Mailing Address - Country:US
Mailing Address - Phone:847-594-1782
Mailing Address - Fax:
Practice Address - Street 1:1975 LIN LOR LN
Practice Address - Street 2:SUITE 10
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-4902
Practice Address - Country:US
Practice Address - Phone:847-697-0770
Practice Address - Fax:847-697-0789
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily