Provider Demographics
NPI:1134484041
Name:HAYES, ELIZABETH ANNE (APN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HAYES
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:SHEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:370 E COURTLAND ST
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-9054
Mailing Address - Country:US
Mailing Address - Phone:309-291-0899
Mailing Address - Fax:309-291-0927
Practice Address - Street 1:370 E COURTLAND ST
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-9054
Practice Address - Country:US
Practice Address - Phone:309-291-0899
Practice Address - Fax:309-291-0927
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.325430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5306016Medicare PIN
IL210426015Medicare PIN