Provider Demographics
NPI:1841568631
Name:SARMIENTO, EDGARDO M JR (NP)
Entity Type:Individual
Prefix:MR
First Name:EDGARDO
Middle Name:M
Last Name:SARMIENTO
Suffix:JR
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:133 WILLOW BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60480-1646
Mailing Address - Country:US
Mailing Address - Phone:773-220-9363
Mailing Address - Fax:
Practice Address - Street 1:808 S WOOD 4TH FLOOR DEPT OF EMERGENCY MEDICINE
Practice Address - Street 2:UNIVERSITY OF ILLINOIS HOSPITAL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7300
Practice Address - Country:US
Practice Address - Phone:773-220-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009054363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care