Provider Demographics
NPI:1285385112
Name:MYERS, DARRIN GLEN
Entity type:Individual
Prefix:
First Name:DARRIN
Middle Name:GLEN
Last Name:MYERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N HAMMES AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8113
Mailing Address - Country:US
Mailing Address - Phone:815-290-0902
Mailing Address - Fax:
Practice Address - Street 1:211 N HAMMES AVE STE 1A
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8113
Practice Address - Country:US
Practice Address - Phone:815-290-0902
Practice Address - Fax:509-753-2503
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker