Healthcare Provider Details

I. General information

NPI: 1376757773
Provider Name (Legal Business Name): MARY LYNNE METZ APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 N CLARK ST STE 907 PRIMARY CARE MEDICAL ASSOCIATES
CHICAGO IL
60614-2720
US

IV. Provider business mailing address

906 N 3RD AVE
MAYWOOD IL
60153-1017
US

V. Phone/Fax

Practice location:
  • Phone: 773-871-4409
  • Fax: 773-871-3608
Mailing address:
  • Phone: 708-287-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: