Provider Demographics
NPI:1629292164
Name:MCCREEDY, TERRI LYN (APN)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:LYN
Last Name:MCCREEDY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6524 BRIARGATE DR
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-3016
Mailing Address - Country:US
Mailing Address - Phone:630-971-1750
Mailing Address - Fax:
Practice Address - Street 1:555 PLAINFIELD RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7602
Practice Address - Country:US
Practice Address - Phone:630-887-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ17718Medicare UPIN