Provider Demographics
NPI:1265642466
Name:SASSO, KAREN MARIE (CNS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:SASSO
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 GOLF RD STE 1275
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1252
Mailing Address - Country:US
Mailing Address - Phone:708-499-9800
Mailing Address - Fax:847-983-4335
Practice Address - Street 1:4709 GOLF RD STE 1275
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1252
Practice Address - Country:US
Practice Address - Phone:708-499-9800
Practice Address - Fax:847-983-4335
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-000705364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILS88003Medicare UPIN