Provider Demographics
NPI:1295775583
Name:PRICE, ELAYNE N (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELAYNE
Middle Name:N
Last Name:PRICE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 S. BRAINARD STREET
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540
Mailing Address - Country:US
Mailing Address - Phone:630-637-5550
Mailing Address - Fax:630-637-5554
Practice Address - Street 1:455 S. BRAINARD STREET
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-637-5550
Practice Address - Fax:630-637-5554
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201724363LF0000X
IL209015065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC15258OtherBCBSNC
NC2808437AMedicare PIN
NCP89522Medicare UPIN