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General NPI Number Information
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NPI Number | 1508351396
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE RUSSEAU APN
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Gender | Female
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 3000 N HALSTED ST STE 320
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City | CHICAGO
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State | IL
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Zip | 60657-5190
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Country | US
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Telephone | 773-296-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 FRANKLIN CT
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City | GURNEE
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State | IL
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Zip | 60031-6307
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Country | US
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Telephone | 847-494-0268
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.017808
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License Number State | IL
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