Healthcare Provider Details

I. General information

NPI: 1154726214
Provider Name (Legal Business Name): JOVI-ANNE C. MYERS APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2014
Last Update Date: 03/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 PARK AVE W
HIGHLAND PARK IL
60035
US

IV. Provider business mailing address

777 PARK AVE W
HIGHLAND PARK IL
60035-2497
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2714
  • Fax: 847-570-1436
Mailing address:
  • Phone: 847-570-2714
  • Fax: 847-570-1436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209011954
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: