Healthcare Provider Details

I. General information

NPI: 1255848214
Provider Name (Legal Business Name): ELAYNA LEAH TEMARES FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SAINT ELIZABETH BLVD STE 5000
O FALLON IL
62269-1099
US

IV. Provider business mailing address

3 SAINT ELIZABETH BLVD STE 5000
O FALLON IL
62269-1099
US

V. Phone/Fax

Practice location:
  • Phone: 618-641-5803
  • Fax:
Mailing address:
  • Phone: 618-641-5803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209017252
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: