Healthcare Provider Details

I. General information

NPI: 1376847533
Provider Name (Legal Business Name): MEGGAN ANNE MIKAL-DEMONT DNP, APRN-FPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-2197
  • Fax: 708-684-4865
Mailing address:
  • Phone: 708-684-2197
  • Fax: 708-684-4865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number209.008520
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.010536
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: