Provider Demographics
NPI:1871372433
Name:CERIM, SAMRA (APN-CNP)
Entity type:Individual
Prefix:
First Name:SAMRA
Middle Name:
Last Name:CERIM
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 RIDGE AVE # 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:
Practice Address - Street 1:731 S. IL ROUTE 21
Practice Address - Street 2:SUITE 130
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3803
Practice Address - Country:US
Practice Address - Phone:847-566-3337
Practice Address - Fax:847-816-3166
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14488-33363L00000X
IL209028444363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner