Provider Demographics
NPI:1700631074
Name:PORTH, MEGAN K (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:K
Last Name:PORTH
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:K
Other - Last Name:ULMANIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7201 NIGHTHAWK WAY
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:IL
Mailing Address - Zip Code:60013-6056
Mailing Address - Country:US
Mailing Address - Phone:815-861-0409
Mailing Address - Fax:
Practice Address - Street 1:7201 NIGHTHAWK WAY
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:IL
Practice Address - Zip Code:60013-6056
Practice Address - Country:US
Practice Address - Phone:815-861-0409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041450880163W00000X
IL209029104363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse