Healthcare Provider Details

I. General information

NPI: 1447673249
Provider Name (Legal Business Name): ELIZABETH STAPLETON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 W FULLERTON AVE
CHICAGO IL
60614-8160
US

IV. Provider business mailing address

1000 REMINGTON BLVD SUITE 100
BOLINGBROOK IL
60440-5114
US

V. Phone/Fax

Practice location:
  • Phone: 773-549-7757
  • Fax: 773-549-1221
Mailing address:
  • Phone: 630-914-2417
  • Fax: 630-914-2499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041196888
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: