Provider Demographics
NPI:1770294290
Name:SHERIDAN, BROOKE (NP)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27W585 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1591
Mailing Address - Country:US
Mailing Address - Phone:708-536-8843
Mailing Address - Fax:
Practice Address - Street 1:693 W BOUGHTON RD
Practice Address - Street 2:
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1752
Practice Address - Country:US
Practice Address - Phone:630-326-8766
Practice Address - Fax:630-326-8768
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily