Basic Information
Provider Information
NPI: 1760938583
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOGEL
FirstName: MEGAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 611 W. PARK ST.
Address2: BWPC
City: URBANA
State: IL
PostalCode: 618012500
CountryCode: US
TelephoneNumber: 2173836941
FaxNumber:  
Practice Location
Address1: 509 W. UNIVERSITY AVE.
Address2: CANCER CENTER
City: URBANA
State: IL
PostalCode: 618011645
CountryCode: US
TelephoneNumber: 2173836636
FaxNumber: 2173833466
Other Information
ProviderEnumerationDate: 08/31/2016
LastUpdateDate: 08/31/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X209014520ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


Home