Provider Demographics
NPI:1831553908
Name:MCFADIN, THERESA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:
Last Name:MCFADIN
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 ILLINI TRL
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-3547
Mailing Address - Country:US
Mailing Address - Phone:618-616-4782
Mailing Address - Fax:
Practice Address - Street 1:6100 ILLINI TRL
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3547
Practice Address - Country:US
Practice Address - Phone:618-616-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013900363L00000X
MO2015040590363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner