Individual
PHYLLIS ANN MYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
2600 FERRY ST, LAFAYETTE, IN 47904-3055
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8335
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
71000071A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000351152
ANTHEM PROVIDER NUMBER
IN
01
—
9397643
PHCS PID NUMBER
IN
Enumeration date
03/23/2006
Last updated
02/01/2008
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