Provider Demographics
NPI:1235938309
Name:GREGORY, ELIZABETH LEE (RN, IBCLC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LEE
Last Name:GREGORY
Suffix:
Gender:
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 W SHERWIN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-2004
Mailing Address - Country:US
Mailing Address - Phone:773-294-8390
Mailing Address - Fax:
Practice Address - Street 1:1432 W SHERWIN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-2004
Practice Address - Country:US
Practice Address - Phone:773-294-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILL-309939163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant