Provider Demographics
NPI:1437464971
Name:SCANLON, ELIZABETH JANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JANE
Last Name:SCANLON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:9 HEARTLAND DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-7732
Mailing Address - Country:US
Mailing Address - Phone:309-663-7642
Mailing Address - Fax:309-663-8359
Practice Address - Street 1:9 HEARTLAND DR
Practice Address - Street 2:SUITE C
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7732
Practice Address - Country:US
Practice Address - Phone:309-663-7642
Practice Address - Fax:309-663-8359
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209.002263363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner