Provider Demographics
NPI:1194324004
Name:BIRDSLEY, ELIZABETH LEA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:LEA
Last Name:BIRDSLEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 RESERVOIR RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:IL
Mailing Address - Zip Code:62631-5012
Mailing Address - Country:US
Mailing Address - Phone:217-323-2118
Mailing Address - Fax:
Practice Address - Street 1:233 S CONGRESS ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62681-1409
Practice Address - Country:US
Practice Address - Phone:217-322-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.021857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily