Healthcare Provider Details

I. General information

NPI: 1548425739
Provider Name (Legal Business Name): ELISABETH ANN GARRISON MSN, ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 07/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 E SCHILLER ST STE 318
ELMHURST IL
60126-2823
US

IV. Provider business mailing address

3406 NORWOOD CIR
NEW LENOX IL
60451-8623
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-1775
  • Fax:
Mailing address:
  • Phone: 815-462-3314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209000470
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: