Basic Information
| Provider Information | |||||||||
| NPI: | 1730515172 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR STE B202 | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154552752 | ||||||||
| FaxNumber: | 8154552789 | ||||||||
| Practice Location | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR STE B202 | ||||||||
| Address2: | |||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8154552752 | ||||||||
| FaxNumber: | 8154552789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2013 | ||||||||
| LastUpdateDate: | 03/18/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 041344050 | IL | N | Nursing Service Providers | Registered Nurse | 363L00000X | 209010892 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2100X | 209010892 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
ID Information
| ID | Type | State | Issuer | Description | 209010892 | 01 | IL | STATE LICENSE | OTHER |