Healthcare Provider Details

I. General information

NPI: 1689173965
Provider Name (Legal Business Name): SARAH ANN SLATTERY NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TRANSAM PLAZA DR STE 100
OAKBROOK TERRACE IL
60181-4286
US

IV. Provider business mailing address

1530 S STATE ST APT 401
CHICAGO IL
60605-2965
US

V. Phone/Fax

Practice location:
  • Phone: 630-627-7500
  • Fax: 630-627-7502
Mailing address:
  • Phone: 773-899-0656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.017139
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: