Healthcare Provider Details

I. General information

NPI: 1063008860
Provider Name (Legal Business Name): JULIE ELIZABETH DI NOVO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2020
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11200 LINCOLN HWY
MOKENA IL
60448-8208
US

IV. Provider business mailing address

2334 OLIVE ST
BLUE ISLAND IL
60406-1604
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone: 773-577-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number277.003149
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277003149
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: