Healthcare Provider Details

I. General information

NPI: 1417926601
Provider Name (Legal Business Name): MERLE EVELYN PRAY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 S0 DAMEN AVE 4292
CHICAGO IL
60612
US

IV. Provider business mailing address

175 E DELAWARE PL 5517
CHICAGO IL
60611-1756
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-7173
  • Fax: 312-569-6110
Mailing address:
  • Phone: 312-569-7173
  • Fax: 312-569-6110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: