Healthcare Provider Details

I. General information

NPI: 1962058925
Provider Name (Legal Business Name): VANNESA MARIE MYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANNESA MARIE MYERS

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 BAY SCOTT CIR STE 109
NAPERVILLE IL
60540-1130
US

IV. Provider business mailing address

713 BERWICK PL
ROSELLE IL
60172-2733
US

V. Phone/Fax

Practice location:
  • Phone: 630-357-2456
  • Fax:
Mailing address:
  • Phone: 928-600-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: