Healthcare Provider Details

I. General information

NPI: 1538978150
Provider Name (Legal Business Name): MEGHAN NOLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ERIE CT STE 6160
OAK PARK IL
60302-2510
US

IV. Provider business mailing address

5461 W LAKE STREET
CHICAGO IL
60644
US

V. Phone/Fax

Practice location:
  • Phone: 708-434-4007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number041423578
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-302112
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: