Healthcare Provider Details

I. General information

NPI: 1437072626
Provider Name (Legal Business Name): SUZANNA RUTH SANCHEZ APRN,CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 CROSS ST STE 240
SHILOH IL
62269-2941
US

IV. Provider business mailing address

PO BOX 959203
SAINT LOUIS MO
63195-9203
US

V. Phone/Fax

Practice location:
  • Phone: 618-234-2390
  • Fax:
Mailing address:
  • Phone: 618-234-2390
  • Fax: 618-234-9936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number209036290
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: