Healthcare Provider Details

I. General information

NPI: 1801302757
Provider Name (Legal Business Name): ELIZABETH CHRISTINE WOODBURY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N HIGHLAND AVE
AURORA IL
60506-3814
US

IV. Provider business mailing address

375 JENICE CT
WEST CHICAGO IL
60185-2987
US

V. Phone/Fax

Practice location:
  • Phone: 630-978-2532
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.016951
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: