Healthcare Provider Details

I. General information

NPI: 1386106961
Provider Name (Legal Business Name): ELIZABETH A SOLIS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 NORTH BLVD STE 208
OAK PARK IL
60301-1149
US

IV. Provider business mailing address

14965 LECLAIRE AVE
OAK FOREST IL
60452-1427
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-4292
  • Fax: 708-848-4886
Mailing address:
  • Phone: 708-582-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209.019195
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: