Provider Demographics
NPI:1821233149
Name:MOTISI, SANDI M (APN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:M
Last Name:MOTISI
Suffix:
Gender:F
Credentials:APN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 165TH ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467-8734
Mailing Address - Country:US
Mailing Address - Phone:708-364-0261
Mailing Address - Fax:
Practice Address - Street 1:900 TECHNOLOGY WAY
Practice Address - Street 2:SUITE 120
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5364
Practice Address - Country:US
Practice Address - Phone:847-231-4721
Practice Address - Fax:847-231-4722
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007380363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily