Basic Information
| Provider Information | |||||||||
| NPI: | 1154726214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MYERS | ||||||||
| FirstName: | JOVI-ANNE | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | APN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 777 PARK AVE W | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600352497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702714 | ||||||||
| FaxNumber: | 8475701436 | ||||||||
| Practice Location | |||||||||
| Address1: | 777 PARK AVE W | ||||||||
| Address2: | |||||||||
| City: | HIGHLAND PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702714 | ||||||||
| FaxNumber: | 8475701436 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2014 | ||||||||
| LastUpdateDate: | 03/12/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 209011954 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 1154726214 | 05 | IL | MEDICAID |