Provider Demographics
NPI:1801510896
Name:MIYAT, MARIAH (DNP, FNP)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:MIYAT
Suffix:
Gender:F
Credentials:DNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E DELAWARE PL STE 306
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4962
Mailing Address - Country:US
Mailing Address - Phone:855-734-3638
Mailing Address - Fax:
Practice Address - Street 1:1 E DELAWARE PL STE 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4962
Practice Address - Country:US
Practice Address - Phone:855-734-3638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.025946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily