Healthcare Provider Details

I. General information

NPI: 1104635002
Provider Name (Legal Business Name): MEGAN ELIZABETH BRASHEARS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. MEGAN ELIZABETH DONLEY

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

720 W GORDON TER APT 12GH
CHICAGO IL
60613-2269
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5000
  • Fax:
Mailing address:
  • Phone: 316-350-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041545271
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: