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General NPI Number Information
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NPI Number | 1275155764
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Entity Type | Individual
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Provider Name | ARIANA SANDOVAL APRN
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Gender | Female
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Dates
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Enumeration Date | 05/07/2020
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Last Update Date | 07/04/2023
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Provider Practice Location Address
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Address Line | 6447 CERMAK RD
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City | BERWYN
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State | IL
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Zip | 60402-2311
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Country | US
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Telephone | 773-254-1400
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Fax |
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Provider Business Mailing Address
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Address Line | 153 CEDARWOOD AVE
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City | BOLINGBROOK
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State | IL
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Zip | 60440-3005
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Country | US
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Telephone | 708-769-0234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.020936
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.020936
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License Number State | IL
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