Provider Demographics
NPI:1144917899
Name:LUIS, JAYA ROBERT (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:JAYA
Middle Name:ROBERT
Last Name:LUIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:JAYA
Other - Middle Name:ROBERT
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:783 WATERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-3718
Mailing Address - Country:US
Mailing Address - Phone:847-909-3196
Mailing Address - Fax:
Practice Address - Street 1:28 N 1ST ST STE 201
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2285
Practice Address - Country:US
Practice Address - Phone:888-428-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-21
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026930363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health