Provider Demographics
NPI:1942210224
Name:ANDERSON, SHARON BENTON (RN APN)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:BENTON
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:RN APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 S MAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3007
Mailing Address - Country:US
Mailing Address - Phone:773-994-3814
Mailing Address - Fax:773-994-3915
Practice Address - Street 1:8131 S MAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3007
Practice Address - Country:US
Practice Address - Phone:773-994-3814
Practice Address - Fax:773-994-3915
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily