Healthcare Provider Details

I. General information

NPI: 1851380257
Provider Name (Legal Business Name): ELLEN K SEDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N SAINT CLAIR ST STE 2140
CHICAGO IL
60611
US

IV. Provider business mailing address

4440 FRANKLIN AVE
WESTERN SPRINGS IL
60558-1529
US

V. Phone/Fax

Practice location:
  • Phone: 312-664-5400
  • Fax:
Mailing address:
  • Phone: 312-342-9530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209-004236
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209004236
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: