Basic Information
| Provider Information | |||||||||
| NPI: | 1912009887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEYER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | C.R.N.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 EAST 12TH STREET | ||||||||
| Address2: | |||||||||
| City: | MENDOTA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613429216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155397461 | ||||||||
| FaxNumber: | 8155391461 | ||||||||
| Practice Location | |||||||||
| Address1: | 1401 EAST 12TH STREET | ||||||||
| Address2: | |||||||||
| City: | MENDOTA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 613429216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8155397461 | ||||||||
| FaxNumber: | 8155391461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2006 | ||||||||
| LastUpdateDate: | 01/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 209003247 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.