Provider Demographics
NPI:1497373286
Name:GAHGAN, MICHELLE T (APRN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:T
Last Name:GAHGAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 FAWN LN
Mailing Address - Street 2:
Mailing Address - City:WONDER LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60097-8451
Mailing Address - Country:US
Mailing Address - Phone:815-653-9002
Mailing Address - Fax:
Practice Address - Street 1:1106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-3482
Practice Address - Country:US
Practice Address - Phone:224-333-0928
Practice Address - Fax:224-209-8685
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021567363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner