=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427325208
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHARON ANN CASEY RN, MN, ANP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/22/2011
-----------------------------------------------------
Last Update Date | 11/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 155 E BRUSH HILL RD B3204
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-5658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-221-0288
-----------------------------------------------------
Fax | 331-221-3851
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 155 E BRUSH HILL RD B3204
-----------------------------------------------------
City | ELMHURST
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60126-5658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 331-221-0288
-----------------------------------------------------
Fax | 331-221-3851
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | 209.002915041.235644
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------