Healthcare Provider Details

I. General information

NPI: 1023426897
Provider Name (Legal Business Name): MEAGAN GRANT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6141 N CICERO AVE
CHICAGO IL
60646-4303
US

IV. Provider business mailing address

2740 W FOSTER AVE STE 310
CHICAGO IL
60625-3547
US

V. Phone/Fax

Practice location:
  • Phone: 773-293-8788
  • Fax: 773-293-8791
Mailing address:
  • Phone: 773-878-8200
  • Fax: 773-293-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.011519
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.011519
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: