Healthcare Provider Details

I. General information

NPI: 1154650968
Provider Name (Legal Business Name): ELIZABETH EILEEN NOLKER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH EILEEN DROEGE

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 S 4TH ST
GREENVILLE IL
62246-2618
US

IV. Provider business mailing address

150 HEALTHCARE DRIVE
GREENVILLE IL
62246-1161
US

V. Phone/Fax

Practice location:
  • Phone: 618-664-1442
  • Fax:
Mailing address:
  • Phone: 618-664-9830
  • Fax: 618-664-9820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209007926
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number277000229
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: