MEDICARE: MS. SARAH GRACE MATULIS FNP-BC

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
1	363LF0000X	Family Nurse Practitioner	209010501	IL

General Provider Information

NPI Number	:	1568804599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH GRACE MATULIS FNP-BC

Provider Business Mailing Address
First Line	:	6338 N CLARK ST APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-1260
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2740 W FOSTER AVE STE 409
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3532
Country	:	US
Telephone Number	:	773-433-3862
Fax Number	:	773-433-3878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2013
Last Update Date	:	07/18/2013

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