Provider Demographics
NPI:1013451509
Name:ELYEA, HEIDIJO
Entity Type:Individual
Prefix:
First Name:HEIDIJO
Middle Name:
Last Name:ELYEA
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 1:1256 WATERFORD DR STE 120
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-4518
Mailing Address - Country:US
Mailing Address - Phone:630-499-6688
Mailing Address - Fax:630-499-6689
Practice Address - Street 1:1256 WATERFORD DRIVE
Practice Address - Street 2:SUITE 120
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504
Practice Address - Country:US
Practice Address - Phone:630-499-6688
Practice Address - Fax:630-499-6689
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015218363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209015218Medicaid