Healthcare Provider Details

I. General information

NPI: 1194269738
Provider Name (Legal Business Name): ERIC M YEAGER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 04/21/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 MEMORIAL DR DEPT ANESTHESIOLOGY
BELLEVILLE IL
62226-5360
US

IV. Provider business mailing address

PO BOX 7412011
CHICAGO IL
60674-2011
US

V. Phone/Fax

Practice location:
  • Phone: 800-862-9980
  • Fax: 314-362-1185
Mailing address:
  • Phone: 800-862-9980
  • Fax: 314-362-1185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209015941
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: