Provider Demographics
NPI:1073983789
Name:SCHEMBRI, ELODIE
Entity Type:Individual
Prefix:
First Name:ELODIE
Middle Name:
Last Name:SCHEMBRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24012 W RENWICK RD
Mailing Address - Street 2:RD 14 & 15
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-2313
Mailing Address - Country:US
Mailing Address - Phone:815-436-9393
Mailing Address - Fax:
Practice Address - Street 1:24012 W RENWICK RD
Practice Address - Street 2:RD 14 & 15
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-2313
Practice Address - Country:US
Practice Address - Phone:815-436-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-07
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209013376363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care