Healthcare Provider Details

I. General information

NPI: 1558446807
Provider Name (Legal Business Name): LUCI SABALA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 CENTER ST SUITE 2001
ELGIN IL
60120-2106
US

IV. Provider business mailing address

915 CENTER ST SUITE 2001
ELGIN IL
60120-2106
US

V. Phone/Fax

Practice location:
  • Phone: 847-931-4200
  • Fax: 847-931-4217
Mailing address:
  • Phone: 847-931-4200
  • Fax: 847-931-4217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: