Provider Demographics
NPI:1952318008
Name:URIBE, SANDRA G (APN, CNM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:G
Last Name:URIBE
Suffix:
Gender:F
Credentials:APN, CNM
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:G
Other - Last Name:URIBE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APN, CNM
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:708-216-9000
Mailing Address - Fax:
Practice Address - Street 1:1 S. 224 SUMMIT AVENUE
Practice Address - Street 2:SUITE 304
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181
Practice Address - Country:US
Practice Address - Phone:630-627-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209006115367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife