Provider Demographics
NPI:1205821923
Name:GINGRICH, SHARRON (NP)
Entity Type:Individual
Prefix:
First Name:SHARRON
Middle Name:
Last Name:GINGRICH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 FEEHANVILLE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-6036
Mailing Address - Country:US
Mailing Address - Phone:847-823-3185
Mailing Address - Fax:847-823-3318
Practice Address - Street 1:2 GOOD SAMARITAN WAY STE 405
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-2478
Practice Address - Country:US
Practice Address - Phone:618-899-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F400297648Medicare PIN
P01797208Medicare PIN
F400297647Medicare PIN
Q48087Medicare UPIN