Provider Demographics
NPI:1639101579
Name:RODGERS, SHERRIE RAE (CPNP)
Entity Type:Individual
Prefix:
First Name:SHERRIE
Middle Name:RAE
Last Name:RODGERS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 N ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4443
Mailing Address - Country:US
Mailing Address - Phone:773-880-3027
Mailing Address - Fax:773-880-3286
Practice Address - Street 1:2300 CHILDREN'S MEMORIAL HOSPITAL
Practice Address - Street 2:MAILBOX #21
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-880-3027
Practice Address - Fax:773-880-3286
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209003032363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics