Healthcare Provider Details

I. General information

NPI: 1770216541
Provider Name (Legal Business Name): IVELISSE SANCHEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

2011 N 74TH CT
ELMWOOD PARK IL
60707-3111
US

V. Phone/Fax

Practice location:
  • Phone: 414-389-2542
  • Fax:
Mailing address:
  • Phone: 773-484-8540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number041331550
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: