Healthcare Provider Details

I. General information

NPI: 1023488475
Provider Name (Legal Business Name): SUMAR ABUSHAQRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 UNION AVE
SHEBOYGAN WI
53081-8426
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-3172
US

V. Phone/Fax

Practice location:
  • Phone: 920-802-2100
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number14723-033
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.013305
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: