Healthcare Provider Details

I. General information

NPI: 1619390655
Provider Name (Legal Business Name): SHERRY L KOBITTER NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2014
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 SYCAMORE ST
VERNON HILLS IL
60061-1082
US

IV. Provider business mailing address

1451 N MILWAUKEE AVE
LIBERTYVILLE IL
60048-1310
US

V. Phone/Fax

Practice location:
  • Phone: 847-845-6000
  • Fax:
Mailing address:
  • Phone: 847-845-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.010948
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: