Provider Demographics
NPI:1366848772
Name:LYERLA, FRANK (PHD, RN)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:LYERLA
Suffix:
Gender:M
Credentials:PHD, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 HOMM ST
Mailing Address - Street 2:
Mailing Address - City:BETHALTO
Mailing Address - State:IL
Mailing Address - Zip Code:62010-1715
Mailing Address - Country:US
Mailing Address - Phone:618-972-4820
Mailing Address - Fax:
Practice Address - Street 1:745 HOMM ST
Practice Address - Street 2:
Practice Address - City:BETHALTO
Practice Address - State:IL
Practice Address - Zip Code:62010-1715
Practice Address - Country:US
Practice Address - Phone:618-972-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO149171163W00000X
IL041.290018163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse