MEDICARE: MISS SARA ELIZABETH ADAMS ANP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	209008205	IL
2	363LA2200X	Adult Health Nurse Practitioner	784785	TX

General Provider Information

NPI Number	:	1902108913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SARA ELIZABETH ADAMS ANP

Provider Business Mailing Address
First Line	:	1130 W GRANVILLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2013
Country	:	US
Telephone Number	:	773-784-6682
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 W GRANVILLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2013
Country	:	US
Telephone Number	:	773-784-6682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	09/16/2015

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