Provider Demographics
NPI:1336678739
Name:FUGELSETH, SARAH BETH (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:FUGELSETH
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:B
Other - Last Name:KOMIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:870 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1521
Mailing Address - Country:US
Mailing Address - Phone:847-475-2273
Mailing Address - Fax:847-535-7761
Practice Address - Street 1:870 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1521
Practice Address - Country:US
Practice Address - Phone:847-475-2273
Practice Address - Fax:847-535-7761
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209019784363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily