Provider Demographics
NPI:1407256696
Name:ILG, MEGHAN LOU (NP ADULT GERO)
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:LOU
Last Name:ILG
Suffix:
Gender:F
Credentials:NP ADULT GERO
Other - Prefix:MRS
Other - First Name:MEGHAN
Other - Middle Name:LOU
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7350 INDUSTRIAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-5318
Mailing Address - Country:US
Mailing Address - Phone:216-732-9480
Mailing Address - Fax:
Practice Address - Street 1:7350 INDUSTRIAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-5318
Practice Address - Country:US
Practice Address - Phone:216-732-9480
Practice Address - Fax:440-942-8431
Is Sole Proprietor?:No
Enumeration Date:2014-08-26
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2014016073363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology