Healthcare Provider Details

I. General information

NPI: 1366848772
Provider Name (Legal Business Name): FRANK LYERLA PHD, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2014
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 HOMM ST
BETHALTO IL
62010-1715
US

IV. Provider business mailing address

745 HOMM ST
BETHALTO IL
62010-1715
US

V. Phone/Fax

Practice location:
  • Phone: 618-972-4820
  • Fax:
Mailing address:
  • Phone: 618-972-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number149171
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.290018
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: