Provider Demographics
NPI:1245635085
Name:HILLEGONDS, SANDRA J
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:HILLEGONDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:BEECHER
Mailing Address - State:IL
Mailing Address - Zip Code:60401-3668
Mailing Address - Country:US
Mailing Address - Phone:708-258-6300
Mailing Address - Fax:708-258-6725
Practice Address - Street 1:127 E. CRAWFORD STREET
Practice Address - Street 2:
Practice Address - City:PEOTONE
Practice Address - State:IL
Practice Address - Zip Code:60468
Practice Address - Country:US
Practice Address - Phone:708-258-6300
Practice Address - Fax:708-258-6725
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily