Healthcare Provider Details

I. General information

NPI: 1205420569
Provider Name (Legal Business Name): MEGHAN MARIE HARRIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

16536 GRANT AVE
ORLAND PARK IL
60467-5372
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax:
Mailing address:
  • Phone: 708-707-7059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number041443466
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: