Provider Demographics
NPI:1699216507
Name:PIECHUR, PATRICE ANN (RN)
Entity Type:Individual
Prefix:MISS
First Name:PATRICE
Middle Name:ANN
Last Name:PIECHUR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:PATRICE
Other - Middle Name:ANN
Other - Last Name:SAKALIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:26118 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60041-8404
Mailing Address - Country:US
Mailing Address - Phone:847-409-9765
Mailing Address - Fax:
Practice Address - Street 1:404 MADISON AVE.
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:IL
Practice Address - Zip Code:60041
Practice Address - Country:US
Practice Address - Phone:847-587-8521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-183331163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse