Provider Demographics
NPI:1801441183
Name:VAN MIEGHEM, BRIANNA CATHERINE (ATC)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:CATHERINE
Last Name:VAN MIEGHEM
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:CATHERINE
Other - Last Name:HEINZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC
Mailing Address - Street 1:625 W MADISON ST APT 911
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2414
Mailing Address - Country:US
Mailing Address - Phone:309-385-2549
Mailing Address - Fax:
Practice Address - Street 1:625 W MADISON ST APT 911
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2414
Practice Address - Country:US
Practice Address - Phone:309-385-2549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960047352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer