Provider Demographics
NPI:1174346118
Name:BRENNAN, MEAGHAN (FNP)
Entity type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:BRENNAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MEAGHAN
Other - Middle Name:
Other - Last Name:MULROE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:119 N KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3107
Mailing Address - Country:US
Mailing Address - Phone:773-405-7136
Mailing Address - Fax:
Practice Address - Street 1:5250 OLD ORCHARD RD STE 300
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-4462
Practice Address - Country:US
Practice Address - Phone:847-920-0902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041481678163W00000X
IL209030671363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse