Provider Demographics
NPI:1942518428
Name:EDWARDS, SARA JANE (ACNP, RN)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:JANE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:ACNP, RN
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:JANE
Other - Last Name:STRNAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP, RN
Mailing Address - Street 1:2160 S 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-3328
Mailing Address - Country:US
Mailing Address - Phone:312-685-5818
Mailing Address - Fax:
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:312-685-5818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-19
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008439363LA2100X
ILIN PROGRESS363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care