Provider Demographics
NPI:1750756979
Name:MISKELL MEDICAL LLC
Entity type:Organization
Organization Name:MISKELL MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MISKELL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:815-431-1122
Mailing Address - Street 1:218 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:OTTAWA
Mailing Address - State:IL
Mailing Address - Zip Code:61350-2819
Mailing Address - Country:US
Mailing Address - Phone:815-431-1122
Mailing Address - Fax:815-431-0318
Practice Address - Street 1:218 W MADISON ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:IL
Practice Address - Zip Code:61350-2819
Practice Address - Country:US
Practice Address - Phone:815-431-1122
Practice Address - Fax:815-431-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363LF0000X
IL209009286261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth ServiceGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1710256631OtherINDIVIDUAL NPI