Provider Demographics
NPI:1073274718
Name:WHITE, SARAH (APN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 S LOUISIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2638
Mailing Address - Country:US
Mailing Address - Phone:309-397-1397
Mailing Address - Fax:
Practice Address - Street 1:104 E QUEENWOOD RD STE 202
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-2962
Practice Address - Country:US
Practice Address - Phone:309-621-9580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021278207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine