Provider Demographics
NPI:1902051121
Name:WHELAN, MEGHAN KATHLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MEGHAN
Middle Name:KATHLEEN
Last Name:WHELAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MEGHAN
Other - Middle Name:KATHLEEN
Other - Last Name:WOLLANGK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:860 SUMMIT ST
Mailing Address - Street 2:SUITE 123
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120
Mailing Address - Country:US
Mailing Address - Phone:847-741-0026
Mailing Address - Fax:847-741-0027
Practice Address - Street 1:860 SUMMIT ST
Practice Address - Street 2:SUITE 123
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120
Practice Address - Country:US
Practice Address - Phone:847-741-0026
Practice Address - Fax:847-741-0027
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085003345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant