Provider Demographics
NPI:1902108913
Name:ADAMS, SARA ELIZABETH (ANP)
Entity Type:Individual
Prefix:MISS
First Name:SARA
Middle Name:ELIZABETH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 W GRANVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2013
Mailing Address - Country:US
Mailing Address - Phone:773-784-6682
Mailing Address - Fax:
Practice Address - Street 1:1130 W GRANVILLE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2013
Practice Address - Country:US
Practice Address - Phone:773-784-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008205363LA2200X
TX784785363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400240943Medicare PIN