Provider Demographics
NPI:1790035053
Name:MCCLELLAN, MEGAN KELLEY (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:KELLEY
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E HURON ST STE 15-738
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:312-926-9218
Mailing Address - Fax:312-926-6134
Practice Address - Street 1:251 E HURON ST STE 15-738
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-9218
Practice Address - Fax:312-926-6134
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.309878-COA1363LA2100X
OHAPRN.CNP.13758363LA2100X
IL209028253363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0088217Medicaid