Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 209007899 | IL |
NPI | 1073840799 |
---|---|
Provider Name | Michael Patrick Meaney |
First Address | Somonauk, IL 60552-9632 |
Second Address | Orland Park, IL 60462-2641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2009 |
Last Update Date | 29/01/2017 |