Provider Demographics
NPI:1770241929
Name:NEELY, MARGARET ANNE (APRN)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANNE
Last Name:NEELY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ANNE
Other - Last Name:WHITED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:4201 WINFIELD RD FL 3
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-4025
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:133 E BRUSH HILL RD STE 310
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5662
Practice Address - Country:US
Practice Address - Phone:331-221-9003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-06
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024478363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner