Healthcare Provider Details

I. General information

NPI: 1962865626
Provider Name (Legal Business Name): SARAH S GREENAWAY APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W MEDICAL CENTER DR STE A200
MCHENRY IL
60050-8437
US

IV. Provider business mailing address

4309 W MEDICAL CENTER DR STE A200
MCHENRY IL
60050-8437
US

V. Phone/Fax

Practice location:
  • Phone: 815-759-8070
  • Fax: 815-759-4931
Mailing address:
  • Phone: 815-759-8070
  • Fax: 815-759-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041384715
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209013666
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: