Provider Demographics
NPI:1922703487
Name:SANCHEZ, ETHAN JOSE EDER (MSN, RN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:ETHAN JOSE
Middle Name:EDER
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MSN, RN, FNP-BC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:735 CHICAGO AVE UNIT 243
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2378
Mailing Address - Country:US
Mailing Address - Phone:409-225-4321
Mailing Address - Fax:
Practice Address - Street 1:1203 W AUGUSTA BLVD STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-4327
Practice Address - Country:US
Practice Address - Phone:773-248-2255
Practice Address - Fax:773-304-4143
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN10068363LF0000X
IL209027034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily