Provider Demographics
NPI:1073596599
Name:MAYER NEAL, LOREL (MSN,CNM)
Entity Type:Individual
Prefix:MS
First Name:LOREL
Middle Name:
Last Name:MAYER NEAL
Suffix:
Gender:F
Credentials:MSN,CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-465-7632
Mailing Address - Fax:615-465-2885
Practice Address - Street 1:5525 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4417
Practice Address - Country:US
Practice Address - Phone:773-585-1955
Practice Address - Fax:773-284-5268
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003672367A00000X
IL277.000976367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS OF IL
IL01621679OtherBCBS OF IL
ILK06945Medicare ID - Type UnspecifiedGROUP 950150