Provider Demographics
NPI:1194113738
Name:RIDDLE, ELIZABETH SUZANNE (RN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SUZANNE
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SUZANNE
Other - Last Name:LEIFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:405 S GLOVER AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61802-3530
Mailing Address - Country:US
Mailing Address - Phone:217-337-5832
Mailing Address - Fax:
Practice Address - Street 1:405 S GLOVER AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61802-3530
Practice Address - Country:US
Practice Address - Phone:217-337-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060349875163WE0003X
IL041.369997163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency