Healthcare Provider Details

I. General information

NPI: 1114383213
Provider Name (Legal Business Name): MARYELLEN FLEMING-PRICE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYELLEN FLEMING-PRICE APN

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 S NAPERVILLE RD STE 206
WHEATON IL
60189-5855
US

IV. Provider business mailing address

1725 S NAPERVILLE RD STE 206
WHEATON IL
60189-5855
US

V. Phone/Fax

Practice location:
  • Phone: 630-653-6441
  • Fax: 630-653-8409
Mailing address:
  • Phone: 630-653-6441
  • Fax: 630-653-8409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist
License Number209.013739
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number041-229053
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: