Provider Demographics
NPI:1811764434
Name:RISTINE, SONYA BRANDON (FNP-BC)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:BRANDON
Last Name:RISTINE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28W302 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-3349
Mailing Address - Country:US
Mailing Address - Phone:630-248-8490
Mailing Address - Fax:
Practice Address - Street 1:2550 HAUSER ROSS DR STE 325
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3180
Practice Address - Country:US
Practice Address - Phone:815-758-7700
Practice Address - Fax:815-756-6103
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041263640163W00000X
IL209028742363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse