Healthcare Provider Details

I. General information

NPI: 1124648811
Provider Name (Legal Business Name): SYDNEY NORDSTROM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2020
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date: 03/18/2021
Reactivation Date: 04/20/2021

III. Provider practice location address

900 RAND RD STE 200
DES PLAINES IL
60016-2359
US

IV. Provider business mailing address

900 RAND RD STE 300
DES PLAINES IL
60016-2359
US

V. Phone/Fax

Practice location:
  • Phone: 847-375-3000
  • Fax:
Mailing address:
  • Phone: 847-324-3976
  • Fax: 847-929-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-008257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: