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NPI Code Detail

MEDICARE: DR. STACEY MARIE MEYERS PHD, APRN, PMHNP-BC

MEDICARE: DR. STACEY MARIE MEYERS PHD, APRN, PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerRN210777GA
2363LP0808XPsychiatric/Mental Health Nurse Practitioner209.021975IL
3363L00000XNurse Practitioner209021975IL

General Provider Information

NPI Number : 1790115293
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. STACEY MARIE MEYERS PHD, APRN, PMHNP-BC
Provider Business Mailing Address
First Line : 676 N SAINT CLAIR ST STE 1100
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2954
Country : US
Telephone Number : 312-695-5060
Fax Number : 312-695-5010
Provider Business Practice Location Address
First Line : 676 N SAINT CLAIR ST STE 1100
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2954
Country : US
Telephone Number : 312-695-5060
Fax Number : 312-695-5010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2013
Last Update Date : 10/07/2022

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