Healthcare Provider Details

I. General information

NPI: 1073523718
Provider Name (Legal Business Name): GERARDO SANCHEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 06/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6785 WEAVER RD STE D
ROCKFORD IL
61114-8055
US

IV. Provider business mailing address

6785 WEAVER RD STE D
ROCKFORD IL
61114-8055
US

V. Phone/Fax

Practice location:
  • Phone: 815-633-8586
  • Fax:
Mailing address:
  • Phone: 815-633-8586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number041-310999
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: