Healthcare Provider Details

I. General information

NPI: 1285879882
Provider Name (Legal Business Name): SARAH E PRINGLE CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2008
Last Update Date: 04/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 MEMORIAL DR STE. 400
BELLEVILLE IL
62226-5368
US

IV. Provider business mailing address

4600 MEMORIAL DR STE. 400
BELLEVILLE IL
62226-5368
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-2390
  • Fax: 618-234-9936
Mailing address:
  • Phone: 618-234-2390
  • Fax: 618-234-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209018609
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: