Healthcare Provider Details

I. General information

NPI: 1083111090
Provider Name (Legal Business Name): LAURIE JEAN MEYERS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2018
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BROOKER CREEK BLVD
OLDSMAR FL
34677-2966
US

IV. Provider business mailing address

385 W WOODWORTH PL
ROSELLE IL
60172-2124
US

V. Phone/Fax

Practice location:
  • Phone: 800-659-1522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.255934
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: