Provider Demographics
NPI:1912729187
Name:MOCKLER, AELEAH LANE (DNP, CRNA)
Entity type:Individual
Prefix:DR
First Name:AELEAH
Middle Name:LANE
Last Name:MOCKLER
Suffix:
Gender:F
Credentials:DNP, CRNA
Other - Prefix:
Other - First Name:AELEAH
Other - Middle Name:LANE
Other - Last Name:HOWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 WEST ARGYLE STREET
Mailing Address - Street 2:APT 501
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6419
Mailing Address - Country:US
Mailing Address - Phone:219-916-5549
Mailing Address - Fax:
Practice Address - Street 1:5700 SOUTH MARYLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1426
Practice Address - Country:US
Practice Address - Phone:219-916-5549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.460864163W00000X
IL209.030868367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse