Healthcare Provider Details

I. General information

NPI: 1992412514
Provider Name (Legal Business Name): ELISA VALLES DNP APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST FL 1
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

2154 W OHIO ST APT 3E
CHICAGO IL
60612-5472
US

V. Phone/Fax

Practice location:
  • Phone: 847-318-9300
  • Fax: 847-723-9583
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209026245
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: