Healthcare Provider Details

I. General information

NPI: 1831614916
Provider Name (Legal Business Name): MEGAN DAVLIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 CAMP CILCA RD
CANTRALL IL
62625
US

IV. Provider business mailing address

1096 1350TH ST
LINCOLN IL
62656-5094
US

V. Phone/Fax

Practice location:
  • Phone: 217-622-7648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209016707
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041401585
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209016707
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: