Provider Demographics
NPI:1780038737
Name:BENNETT, SARAH (APN, ATC)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BENNETT
Suffix:
Gender:F
Credentials:APN, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504-7597
Mailing Address - Country:US
Mailing Address - Phone:630-978-3800
Mailing Address - Fax:308-623-0856
Practice Address - Street 1:2111 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-7597
Practice Address - Country:US
Practice Address - Phone:630-978-3800
Practice Address - Fax:630-862-3085
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL096.0028692255A2300X
IL209016726363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer