Provider Demographics
NPI:1447924022
Name:HEDERMAN, ELIZABETH A (FNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:HEDERMAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1890 SILVER CROSS BLVD STE 370
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-9607
Mailing Address - Country:US
Mailing Address - Phone:815-717-8727
Mailing Address - Fax:
Practice Address - Street 1:1890 SILVER CROSS BLVD STE 370
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-9607
Practice Address - Country:US
Practice Address - Phone:815-717-8727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022590363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209022590OtherIDFPR
ILF11200411OtherAANP