Healthcare Provider Details

I. General information

NPI: 1972107894
Provider Name (Legal Business Name): ELIZABETH VO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 10/03/2021
Certification Date: 10/03/2021
Deactivation Date: 02/27/2021
Reactivation Date: 06/08/2021

III. Provider practice location address

1551 BOND ST #143
NAPERVILLE IL
60563-1965
US

IV. Provider business mailing address

1551 BOND ST #143
NAPERVILLE IL
60563
US

V. Phone/Fax

Practice location:
  • Phone: 877-726-6494
  • Fax:
Mailing address:
  • Phone: 877-726-6494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209022937
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number041415601
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: