Healthcare Provider Details

I. General information

NPI: 1518364991
Provider Name (Legal Business Name): MEGAN WITKOWSKI NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN PIPER RN, BSN

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST 2 SOUTH
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-5386
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number209.012248
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209012248
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: