Provider Demographics
NPI:1568189199
Name:MERCADO, MEGHAN (CNM)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:
Last Name:MERCADO
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:
Other - Last Name:LENZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2221 LEVIN CREST LN
Mailing Address - Street 2:
Mailing Address - City:DUPO
Mailing Address - State:IL
Mailing Address - Zip Code:62239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2221 LEVIN CREST LN
Practice Address - Street 2:
Practice Address - City:DUPO
Practice Address - State:IL
Practice Address - Zip Code:62239
Practice Address - Country:US
Practice Address - Phone:618-789-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025633367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife