Provider Demographics
NPI:1346711553
Name:MITCHELL, MEGHAN A (FNP)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ELDORADO
Mailing Address - State:IL
Mailing Address - Zip Code:62930-1634
Mailing Address - Country:US
Mailing Address - Phone:618-273-3361
Mailing Address - Fax:618-273-2504
Practice Address - Street 1:1306 MAPLE ST
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930-1662
Practice Address - Country:US
Practice Address - Phone:618-273-3361
Practice Address - Fax:618-273-2504
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209018518OtherILLINOIS STATE LICENSE