Provider Demographics
NPI:1063178036
Name:MASTERS, ELIZABETH JOY (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOY
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 RIVERBEND LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HEATH
Mailing Address - State:IL
Mailing Address - Zip Code:61884-9300
Mailing Address - Country:US
Mailing Address - Phone:630-373-8201
Mailing Address - Fax:
Practice Address - Street 1:1400 W PARK ST
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2334
Practice Address - Country:US
Practice Address - Phone:217-337-2676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-13
Last Update Date:2021-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209024189363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner