Provider Demographics
NPI:1407468093
Name:SANDERS, ELLEN C (PA-C)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:C
Last Name:SANDERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 N SAINT CLAIR ST STE 19-100
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5969
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:312-695-0063
Practice Address - Street 1:675 N SAINT CLAIR ST STE 19-100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5969
Practice Address - Country:US
Practice Address - Phone:312-572-4500
Practice Address - Fax:312-695-0063
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085007656363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant