Healthcare Provider Details

I. General information

NPI: 1770083784
Provider Name (Legal Business Name): SANA ATCHA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TIFFANY PT STE 106
BLOOMINGDALE IL
60108-2915
US

IV. Provider business mailing address

1 TIFFANY PT STE 106
BLOOMINGDALE IL
60108-2915
US

V. Phone/Fax

Practice location:
  • Phone: 224-653-9507
  • Fax: 224-653-9387
Mailing address:
  • Phone: 224-653-9507
  • Fax: 224-653-9387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209017115
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: