Provider Demographics
NPI:1710217930
Name:PAUL, SHERI LYNN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:LYNN
Last Name:PAUL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 W COLLEGE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1152
Mailing Address - Country:US
Mailing Address - Phone:708-671-9290
Mailing Address - Fax:708-671-9295
Practice Address - Street 1:7300 W COLLEGE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1152
Practice Address - Country:US
Practice Address - Phone:708-671-9290
Practice Address - Fax:708-671-9295
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-11
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL029007875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209007875OtherILLINOIS LICENSE NUMBER