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General NPI Number Information
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NPI Number | 1811764434
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Entity Type | Individual
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Provider Name | SONYA BRANDON RISTINE FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 2550 HAUSER ROSS DR STE 325
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City | SYCAMORE
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State | IL
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Zip | 60178-3180
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Country | US
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Telephone | 815-758-7700
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Fax | 815-756-6103
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Provider Business Mailing Address
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Address Line | 28W302 JACKSON ST
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City | WARRENVILLE
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State | IL
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Zip | 60555-3349
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Country | US
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Telephone | 630-248-8490
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209028742
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041263640
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License Number State | IL
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