Provider Demographics
NPI:1629497409
Name:HRIBERNIK, MEGAN (NP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:HRIBERNIK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6413
Mailing Address - Country:US
Mailing Address - Phone:815-744-8554
Mailing Address - Fax:630-462-8680
Practice Address - Street 1:2256 W HILL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4655
Practice Address - Country:US
Practice Address - Phone:810-249-7546
Practice Address - Fax:734-464-0335
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268904363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1629497409Medicaid
NC1629497409OtherMEDCOST
NC5280947OtherAETNA
NC4361417OtherUNITED HEALTHCARE
NC18510OtherBCBS
NCNCH940AMedicare PIN
NC1629497409OtherTRICARE
NCQNP256OtherSC MEDICAID