Provider Demographics
NPI:1952885865
Name:DURR-BAXTER, ELSA ELLENA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:ELLENA
Last Name:DURR-BAXTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:ELSA
Other - Middle Name:ELLENA
Other - Last Name:DURR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1929 10TH AVE E
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:IL
Mailing Address - Zip Code:61264-2953
Mailing Address - Country:US
Mailing Address - Phone:309-787-2600
Mailing Address - Fax:309-787-2643
Practice Address - Street 1:1929 10TH AVE E
Practice Address - Street 2:
Practice Address - City:MILAN
Practice Address - State:IL
Practice Address - Zip Code:61264-2953
Practice Address - Country:US
Practice Address - Phone:309-787-2600
Practice Address - Fax:309-787-2643
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA117905363LF0000X
IL209021773363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily