Healthcare Provider Details

I. General information

NPI: 1932342680
Provider Name (Legal Business Name): RORY P BRESLIN-SANI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON STREET SUITE 855
CHICAGO IL
60612
US

IV. Provider business mailing address

1725 W HARRISON STREET SUITE 855
CHICAGO IL
60612
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6644
  • Fax:
Mailing address:
  • Phone: 312-942-6644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number041-346436
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209007523
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: