Provider Demographics
NPI:1942465554
Name:ULERY, MARYANN (APN)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:ULERY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 AUSTRIAN CT
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-6515
Mailing Address - Country:US
Mailing Address - Phone:815-519-8525
Mailing Address - Fax:
Practice Address - Street 1:3 AUSTRIAN CT
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-6515
Practice Address - Country:US
Practice Address - Phone:815-519-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007147363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041258419OtherRN LICENSE