Provider Demographics
NPI:1376757773
Name:METZ, MARY LYNNE (APRN, BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LYNNE
Last Name:METZ
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1017
Mailing Address - Country:US
Mailing Address - Phone:708-287-0540
Mailing Address - Fax:
Practice Address - Street 1:2515 N CLARK ST STE 907
Practice Address - Street 2:PRIMARY CARE MEDICAL ASSOCIATES
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2720
Practice Address - Country:US
Practice Address - Phone:773-871-4409
Practice Address - Fax:773-871-3608
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202896Medicare ID - Type Unspecified