Provider Demographics
NPI:1609265149
Name:SACCO, CAROL MARY (MSN, ANP, NP-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MARY
Last Name:SACCO
Suffix:
Gender:F
Credentials:MSN, ANP, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 W FREMONT ST
Mailing Address - Street 2:
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2436
Mailing Address - Country:US
Mailing Address - Phone:309-344-2225
Mailing Address - Fax:309-344-2230
Practice Address - Street 1:1361 W FREMONT ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2436
Practice Address - Country:US
Practice Address - Phone:309-344-2225
Practice Address - Fax:309-344-2230
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011849363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily