Provider Demographics
NPI:1114383213
Name:FLEMING-PRICE, MARYELLEN (APN)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:
Last Name:FLEMING-PRICE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:MARYELLEN
Other - Middle Name:
Other - Last Name:FLEMING-PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1725 S NAPERVILLE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5855
Mailing Address - Country:US
Mailing Address - Phone:630-653-6441
Mailing Address - Fax:630-653-8409
Practice Address - Street 1:1725 S NAPERVILLE RD STE 206
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5855
Practice Address - Country:US
Practice Address - Phone:630-653-6441
Practice Address - Fax:630-653-8409
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.013739364SP0807X
IL041-229053363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent