Provider Demographics
NPI:1619390655
Name:KOBITTER, SHERRY L (NP-BC)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:L
Last Name:KOBITTER
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1310
Mailing Address - Country:US
Mailing Address - Phone:847-845-6000
Mailing Address - Fax:
Practice Address - Street 1:525 SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1082
Practice Address - Country:US
Practice Address - Phone:847-845-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010948363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner