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General NPI Number Information
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NPI Number | 1699560151
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Entity Type | Organization
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Legal Business Name | MIORA
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Dates
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Enumeration Date | 04/14/2025
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 1618 SHERMAN AVE
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City | EVANSTON
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State | IL
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Zip | 60201-3711
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Country | US
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Telephone | 855-430-5433
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Fax |
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Provider Business Mailing Address
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Address Line | 1618 SHERMAN AVE
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City | EVANSTON
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State | IL
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Zip | 60201-3711
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Country | US
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Telephone | 855-430-5433
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | ARIELLE DOVER JANICEK
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Credential | APRN
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Telephone | 866-770-1588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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