Healthcare Provider Details

I. General information

NPI: 1376673905
Provider Name (Legal Business Name): SHERYL CODDINGTON R.N., MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S WOLF RD
HILLSIDE IL
60162-2110
US

IV. Provider business mailing address

630 FOREST AVE
OAK PARK IL
60302-1604
US

V. Phone/Fax

Practice location:
  • Phone: 708-236-0979
  • Fax: 708-236-5161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: