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NPI Code Detail

MEDICARE: SKY ESPE

MEDICARE: SKY ESPE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner209027056IL

General Provider Information

NPI Number : 1285322495
Entity Type Code : Individual
Provider Name (Legal Business Name) : SKY ESPE
Provider Business Mailing Address
First Line : 265 STONEGATE RD STE 102
Second Line :
City : ALGONQUIN
State : IL
Zip : 60102-5614
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1137 MCHENRY RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-1377
Country : US
Telephone Number : 847-807-8777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2023
Last Update Date : 07/29/2024

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Directions to “ SKY ESPE ” Practice Location

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