Provider Demographics
NPI:1588211478
Name:RICH, MEGAN
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17985 N 2800 EAST RD
Mailing Address - Street 2:
Mailing Address - City:SAUNEMIN
Mailing Address - State:IL
Mailing Address - Zip Code:61769-6071
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17985 N 2800 EAST RD
Practice Address - Street 2:
Practice Address - City:SAUNEMIN
Practice Address - State:IL
Practice Address - Zip Code:61769-6071
Practice Address - Country:US
Practice Address - Phone:317-625-4491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-24
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.442604163W00000X
IL209022222363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse