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General NPI Number Information
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NPI Number | 1912057803
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Entity Type | Individual
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Provider Name | SARAH JANE EHRHARDT PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 02/20/2014
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Provider Practice Location Address
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Address Line | 9921 SOUTHWEST HWY
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City | OAK LAWN
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State | IL
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Zip | 60453-3767
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Country | US
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Telephone | 708-499-5678
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Fax | 708-499-5685
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Provider Business Mailing Address
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Address Line | 1801 W TAYLOR ST 1-E OCC
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City | CHICAGO
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State | IL
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Zip | 60612-4795
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Country | US
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Telephone | 312-355-5004
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Fax | 312-355-1515
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 085.002840
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License Number State | IL
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