Healthcare Provider Details

I. General information

NPI: 1467247445
Provider Name (Legal Business Name): NATHANIEL JAYMES SISLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

0S036 CHURCH ST STE 300
WINFIELD IL
60190-1203
US

IV. Provider business mailing address

0S036 CHURCH ST STE 300
WINFIELD IL
60190-1203
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-1800
  • Fax: 630-938-8849
Mailing address:
  • Phone: 312-695-1800
  • Fax: 630-938-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085012257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: