Provider Demographics
NPI:1417047135
Name:OWEN, SHERRY (APN)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 S IL ROUTE 21 STE 140
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3812
Mailing Address - Country:US
Mailing Address - Phone:847-942-7260
Mailing Address - Fax:847-336-2771
Practice Address - Street 1:731 S IL ROUTE 21 STE 140
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3812
Practice Address - Country:US
Practice Address - Phone:847-942-7260
Practice Address - Fax:847-336-2771
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001762363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204116Medicare ID - Type Unspecified
ILP77548Medicare UPIN