Provider Demographics
NPI:1376847533
Name:MIKAL, MEGGAN ANNE (APN, PCNS-BC, CPNP)
Entity Type:Individual
Prefix:
First Name:MEGGAN
Middle Name:ANNE
Last Name:MIKAL
Suffix:
Gender:F
Credentials:APN, PCNS-BC, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2600
Mailing Address - Country:US
Mailing Address - Phone:708-684-2197
Mailing Address - Fax:708-684-4865
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2600
Practice Address - Country:US
Practice Address - Phone:708-684-2197
Practice Address - Fax:708-684-4865
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010536363LP0200X
IL209.008520364SP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No364SP0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPediatrics