Basic Information
| Provider Information | |||||||||
| NPI: | 1720240914 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FORD | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | NNP, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3408 OFFICE PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629596477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189975266 | ||||||||
| FaxNumber: | 6189975285 | ||||||||
| Practice Location | |||||||||
| Address1: | 3412 OFFICE PARK DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629596477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189930404 | ||||||||
| FaxNumber: | 6189931717 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2008 | ||||||||
| LastUpdateDate: | 06/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209.005689 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LN0000X | 2001026744 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal |
No ID Information.