Provider Demographics
NPI:1184144081
Name:NAVIDSON, ELLIE (RN)
Entity type:Individual
Prefix:
First Name:ELLIE
Middle Name:
Last Name:NAVIDSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:GRAHAM
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1015 W LAWRENCE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-5017
Mailing Address - Country:US
Mailing Address - Phone:773-275-1737
Mailing Address - Fax:773-275-3689
Practice Address - Street 1:1015 W LAWRENCE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640
Practice Address - Country:US
Practice Address - Phone:773-275-1737
Practice Address - Fax:773-275-3689
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.447431163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse