Provider Demographics
NPI:1942458260
Name:KELSO, SARAH E (RN, APN/CPNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:KELSO
Suffix:
Gender:F
Credentials:RN, APN/CPNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:FEDEWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4611 GOLF RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1209
Mailing Address - Country:US
Mailing Address - Phone:847-676-5394
Mailing Address - Fax:847-679-7183
Practice Address - Street 1:4611 GOLF RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1209
Practice Address - Country:US
Practice Address - Phone:847-676-5394
Practice Address - Fax:847-679-7183
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007232363LP0200X
IL041338008163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics