Healthcare Provider Details

I. General information

NPI: 1821688466
Provider Name (Legal Business Name): JONATHAN SABO BSN, RN, CCRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2021
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 E CARPENTER ST
SPRINGFIELD IL
62769-1000
US

IV. Provider business mailing address

1305 WALT WHITMAN RD STE 300
MELVILLE NY
11747-4300
US

V. Phone/Fax

Practice location:
  • Phone: 217-544-6464
  • Fax:
Mailing address:
  • Phone: 516-945-3347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number041555931
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN706986
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209029373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: