Healthcare Provider Details

I. General information

NPI: 1699960088
Provider Name (Legal Business Name): SARAH JEAN TUOHY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH JEAN GRABOWSKI

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2361 PAYSPHERE CIR
CHICAGO IL
60674
US

IV. Provider business mailing address

6308 8TH AVE
KENOSHA WI
53143-5031
US

V. Phone/Fax

Practice location:
  • Phone: 847-746-4358
  • Fax: 262-687-8796
Mailing address:
  • Phone: 262-656-3178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3210-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.008022
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: