Healthcare Provider Details

I. General information

NPI: 1134148919
Provider Name (Legal Business Name): CYNTHIA GAIL ELLIOTT-ZIPPE APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA GAIL SHARP

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 9TH ST SUITE 200
ROCKFORD IL
61104
US

IV. Provider business mailing address

PO BOX 78866
MILWAUKEE WI
53278-8866
US

V. Phone/Fax

Practice location:
  • Phone: 779-696-2750
  • Fax:
Mailing address:
  • Phone: 779-696-7150
  • Fax: 779-696-7342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number209003701
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: