MEDICARE: MS. CASEY ELIZABETH HENRY APN-CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	277001204	IL
2	363LF0000X	Family Nurse Practitioner	209007844	IL

General Provider Information

NPI Number	:	1871821884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CASEY ELIZABETH HENRY APN-CNP

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE # 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-982-3175
Fax Number	:	847-982-3394

Provider Business Practice Location Address
First Line	:	303 W LAKE ST
Second Line	:
City	:	ADDISON
State	:	IL
Zip	:	60101-2586
Country	:	US
Telephone Number	:	630-527-3645
Fax Number	:	331-221-3983

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2009
Last Update Date	:	03/10/2026

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