Healthcare Provider Details

I. General information

NPI: 1508753302
Provider Name (Legal Business Name): SIERRA BECKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 PFINGSTEN RD
GLENVIEW IL
60026-1301
US

IV. Provider business mailing address

129 HILLSHIRE CT
INVERNESS IL
60010-6439
US

V. Phone/Fax

Practice location:
  • Phone: 847-657-5800
  • Fax:
Mailing address:
  • Phone: 847-804-3270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085011300
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: