1689942500 NPI number — ALICE MARIE SARTORE APN

Table of content: ALICE MARIE SARTORE APN (NPI 1689942500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689942500 NPI number — ALICE MARIE SARTORE APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARTORE
Provider First Name:
ALICE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689942500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22207 S GAWAIN DR
Provider Second Line Business Mailing Address:
22207 SOUTH GAWAIN DRIVE
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60404-6678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-919-7431
Provider Business Mailing Address Fax Number:
815-301-1749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2055 W ARMY TRAIL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADDISON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60101-1478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-705-1739
Provider Business Practice Location Address Fax Number:
630-705-1049
Provider Enumeration Date:
12/06/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LX0001X , with the licence number:  209003753 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)