Healthcare Provider Details

I. General information

NPI: 1932179751
Provider Name (Legal Business Name): SHARON M BODE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 N RANDALL RD STE 201
ELGIN IL
60123
US

IV. Provider business mailing address

1435 N RANDALL RD STE 201
ELGIN IL
60123
US

V. Phone/Fax

Practice location:
  • Phone: 847-695-3168
  • Fax: 847-695-4289
Mailing address:
  • Phone: 847-695-3168
  • Fax: 847-695-4289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.007890
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number117826
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: