Healthcare Provider Details

I. General information

NPI: 1841691094
Provider Name (Legal Business Name): MEREDITH MCCLURE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W. FULTON
CHICAGO IL
60661-1262
US

IV. Provider business mailing address

4544 N CHRISTIANA AVE APT 3
CHICAGO IL
60625-5452
US

V. Phone/Fax

Practice location:
  • Phone: 847-636-0681
  • Fax:
Mailing address:
  • Phone: 847-636-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209011807
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015809
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209011807
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: