Healthcare Provider Details

I. General information

NPI: 1720942808
Provider Name (Legal Business Name): ELIZABETH A. VENICE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5775 IL-113
COAL CITY IL
60416
US

IV. Provider business mailing address

26010 W SYLVAN MEADOW DR
CHANNAHON IL
60410-3442
US

V. Phone/Fax

Practice location:
  • Phone: 815-634-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.034036
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: