Healthcare Provider Details

I. General information

NPI: 1073596599
Provider Name (Legal Business Name): LOREL MAYER NEAL MSN,CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 S PULASKI RD
CHICAGO IL
60629-4417
US

IV. Provider business mailing address

PO BOX 689022
FRANKLIN TN
37068-9022
US

V. Phone/Fax

Practice location:
  • Phone: 773-585-1955
  • Fax: 773-284-5268
Mailing address:
  • Phone: 615-465-7632
  • Fax: 615-465-2885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209003672
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number277.000976
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: