Healthcare Provider Details

I. General information

NPI: 1942750492
Provider Name (Legal Business Name): SARAH L GRABERT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 E HURON ST STE 16E
CHICAGO IL
60611-2908
US

IV. Provider business mailing address

5061 N LINCOLN AVE 402
CHICAGO IL
60625
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-0665
  • Fax: 312-695-6594
Mailing address:
  • Phone: 330-720-9465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209014688
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: