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NPI Code Detail

MEDICARE: SABLE FORD FNP

MEDICARE: SABLE FORD FNP
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
1363L00000XNurse Practitioner209035853IL

General Provider Information

NPI Number : 1477489508
Entity Type Code : Individual
Provider Name (Legal Business Name) : SABLE FORD FNP
Provider Business Mailing Address
First Line : 2320 E 93RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-3909
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2320 E 93RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60617-3909
Country : US
Telephone Number : 708-934-5800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2026
Last Update Date : 06/18/2026

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Directions to “ SABLE FORD FNP” Practice Location

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