Healthcare Provider Details

I. General information

NPI: 1609987148
Provider Name (Legal Business Name): PAMELA RUTH SYKES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date: 10/27/2020
Reactivation Date: 11/10/2020

III. Provider practice location address

3001 GREEN BAY RD
NORTH CHICAGO IL
60064-3048
US

IV. Provider business mailing address

270 GLENWOOD RD
LAKE FOREST IL
60045-3065
US

V. Phone/Fax

Practice location:
  • Phone: 847-688-1900
  • Fax:
Mailing address:
  • Phone: 847-735-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number12173630
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: