Healthcare Provider Details

I. General information

NPI: 1013451509
Provider Name (Legal Business Name): HEIDIJO ELYEA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 JUSTICE WAY ROOM C0049
INDIANAPOLIS IN
46203
US

IV. Provider business mailing address

1256 WATERFORD DR STE 120
AURORA IL
60504-4518
US

V. Phone/Fax

Practice location:
  • Phone: 877-465-6650
  • Fax: 804-294-2775
Mailing address:
  • Phone: 630-499-6688
  • Fax: 630-499-6689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209015218
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: