Healthcare Provider Details

I. General information

NPI: 1760436109
Provider Name (Legal Business Name): CHERYL ANN BOSS ANP-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15300 WEST AVE SUITE 122 SOUTH
ORLAND PARK IL
60462-4600
US

IV. Provider business mailing address

12251 S 80TH AVE SUITE 1630
PALOS HEIGHTS IL
60463-1256
US

V. Phone/Fax

Practice location:
  • Phone: 708-403-8400
  • Fax: 708-403-8492
Mailing address:
  • Phone: 708-923-5173
  • Fax: 708-923-5018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.005516
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209005516
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: