Provider Demographics
NPI:1841054632
Name:MYERS, ELAINE ILENE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:ILENE
Last Name:MYERS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 S LEBANON ST STE C
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-3077
Mailing Address - Country:US
Mailing Address - Phone:765-680-0071
Mailing Address - Fax:
Practice Address - Street 1:1310 S LEBANON ST STE C
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-3077
Practice Address - Country:US
Practice Address - Phone:765-680-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28119081A163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Multi-Specialty