Provider Demographics
NPI:1386014629
Name:SANCHEZ, CARMELA (PA)
Entity Type:Individual
Prefix:
First Name:CARMELA
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CARMELA
Other - Middle Name:
Other - Last Name:PILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:195 WAUKEGAN RD
Mailing Address - Street 2:#371
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:312-771-9908
Mailing Address - Fax:
Practice Address - Street 1:195 WAUKEGAN RD
Practice Address - Street 2:#371
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:312-771-9908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-005679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant