Healthcare Provider Details

I. General information

NPI: 1316389570
Provider Name (Legal Business Name): SHERIDAN KEETER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 S DAMEN AVE STE 210
CHICAGO IL
60608-1169
US

IV. Provider business mailing address

1340 S DAMEN AVE STE 210
CHICAGO IL
60608-1169
US

V. Phone/Fax

Practice location:
  • Phone: 773-292-4800
  • Fax: 773-384-7053
Mailing address:
  • Phone: 773-292-4800
  • Fax: 773-384-7053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95001343
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209010426
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: