Healthcare Provider Details

I. General information

NPI: 1255073136
Provider Name (Legal Business Name): SARAH ANNE MATHIASON DNP, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2022
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 N CLARK ST
CHICAGO IL
60610-5467
US

IV. Provider business mailing address

2530 N ASHLAND AVE APT 2N
CHICAGO IL
60614-7788
US

V. Phone/Fax

Practice location:
  • Phone: 312-943-6964
  • Fax:
Mailing address:
  • Phone: 630-363-5149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number041444774
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209025818
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: