Provider Demographics
NPI:1417411307
Name:PAULOSE, SINU (APRN)
Entity Type:Individual
Prefix:
First Name:SINU
Middle Name:
Last Name:PAULOSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5600 W ADDISON ST LOWR 1LL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4444
Mailing Address - Country:US
Mailing Address - Phone:773-202-9622
Mailing Address - Fax:
Practice Address - Street 1:5600 W ADDISON ST LOWR 1LL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4444
Practice Address - Country:US
Practice Address - Phone:773-202-9622
Practice Address - Fax:773-283-0901
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018690363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily