Healthcare Provider Details

I. General information

NPI: 1811204076
Provider Name (Legal Business Name): MEGAN MARIE MCINTYRE MSN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 N SAINT CLAIR ST STE 18-200
CHICAGO IL
60611-5929
US

IV. Provider business mailing address

675 N SAINT CLAIR ST STE 18-200
CHICAGO IL
60611-5929
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-4525
  • Fax: 312-503-3350
Mailing address:
  • Phone: 312-695-4525
  • Fax: 312-503-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11643
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209008448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: