Provider Demographics
NPI:1144733783
Name:SAOUR, REBECCA ANN (APRN, CNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:SAOUR
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:VANNORSDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNP
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 19-100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5969
Mailing Address - Country:US
Mailing Address - Phone:312-664-3278
Mailing Address - Fax:312-695-5774
Practice Address - Street 1:3825 HIGHLAND AVE FL TOWER24
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1552
Practice Address - Country:US
Practice Address - Phone:630-719-4799
Practice Address - Fax:630-963-7420
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60956072363L00000X, 363LF0000X
IL209-016518363L00000X
IL277002369363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1144733783Medicaid