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General NPI Number Information
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NPI Number | 1710603121
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Entity Type | Individual
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Provider Name | MEGAN PAIGE GRIESMAN APRN
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Gender | Female
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 875 S ROUTE 31
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City | CRYSTAL LAKE
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State | IL
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Zip | 60014-8190
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Country | US
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Telephone | 779-220-5500
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Fax | 779-220-5184
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Provider Business Mailing Address
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Address Line | 1200 W STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61102-2112
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Country | US
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Telephone | 815-490-1600
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Fax | 815-490-1881
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209026136
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209026136
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License Number State | IL
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