Provider Demographics
NPI:1558446807
Name:SABALA, LUCI (NP)
Entity Type:Individual
Prefix:MS
First Name:LUCI
Middle Name:
Last Name:SABALA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 CENTER ST
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-2106
Mailing Address - Country:US
Mailing Address - Phone:847-931-4200
Mailing Address - Fax:847-931-4217
Practice Address - Street 1:915 CENTER ST
Practice Address - Street 2:SUITE 2001
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-2106
Practice Address - Country:US
Practice Address - Phone:847-931-4200
Practice Address - Fax:847-931-4217
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ09181Medicare UPIN
ILK21783Medicare PIN