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General NPI Number Information
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NPI Number | 1710598123
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Entity Type | Individual
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Provider Name | MEGHAN KAWAHARA
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Gender | Female
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 225 E CHICAGO AVE # 21
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City | CHICAGO
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State | IL
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Zip | 60611-2991
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Country | US
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Telephone | 312-227-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2951 N CLYBOURN AVE UNIT 307
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City | CHICAGO
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State | IL
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Zip | 60618-8199
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Country | US
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Telephone | 708-712-7136
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 209.021737
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License Number State | IL
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