Healthcare Provider Details

I. General information

NPI: 1487910576
Provider Name (Legal Business Name): SARA E. REYNOLDS APN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE. KELLOGG CANCER CENTER
EVANSTON IL
60201
US

IV. Provider business mailing address

2650 RIDGE AVE. KELLOGG CANCER CENTER
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-2112
  • Fax: 847-570-1041
Mailing address:
  • Phone: 847-570-2112
  • Fax: 847-570-1041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209009316
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: