Healthcare Provider Details

I. General information

NPI: 1154792406
Provider Name (Legal Business Name): SHARA ANN BRANKIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHARA ANN MARISSA WEIDACHER

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N RANDALL RD
ELGIN IL
60123-2300
US

IV. Provider business mailing address

2650 RIDGE AVE
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 630-408-3902
  • Fax:
Mailing address:
  • Phone: 847-570-2040
  • Fax: 847-733-5315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277003144
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277003144
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA181345
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: