Healthcare Provider Details

I. General information

NPI: 1114707007
Provider Name (Legal Business Name): EMILY ANNE GREAVES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY PERRY FNP

II. Dates (important events)

Enumeration Date: 09/29/2023
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 KISH HOSPITAL DR STE 103
DEKALB IL
60115-9602
US

IV. Provider business mailing address

5 KISH HOSPITAL DR STE 103
DEKALB IL
60115-9602
US

V. Phone/Fax

Practice location:
  • Phone: 630-232-0280
  • Fax: 630-232-3895
Mailing address:
  • Phone: 630-232-0280
  • Fax: 630-232-3895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.028345
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: