Provider Demographics
NPI:1871217653
Name:KADUSHIN, MEGAN (APRN, FNP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KADUSHIN
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 S IL ROUTE 21 STE 110
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3803
Mailing Address - Country:US
Mailing Address - Phone:224-424-4129
Mailing Address - Fax:
Practice Address - Street 1:731 S IL ROUTE 21
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3813
Practice Address - Country:US
Practice Address - Phone:224-424-4129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209025979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily