Provider Demographics
NPI:1972702975
Name:MEYER, ARLENE PHYLLIS (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:ARLENE
Middle Name:PHYLLIS
Last Name:MEYER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-933-4480
Mailing Address - Fax:630-933-2009
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-933-4480
Practice Address - Fax:630-933-2009
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005308363L00000X
IL209-005308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147204OtherMEDICARE (INDIVIDUAL)
IL206147OtherMEDICARE (GROUP)
IL206147204OtherMEDICARE (INDIVIDUAL)