Healthcare Provider Details

I. General information

NPI: 1821680232
Provider Name (Legal Business Name): MS. SARIETTE NGANDJO YEPNDJOUO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2021
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24012 W RENWICK RD
PLAINFIELD IL
60544-8722
US

IV. Provider business mailing address

125 YARROW
ROMEOVILLE IL
60446-3951
US

V. Phone/Fax

Practice location:
  • Phone: 331-330-7228
  • Fax: 775-459-7002
Mailing address:
  • Phone: 630-617-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277.003845
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041465208
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: