Provider Demographics
NPI:1881931384
Name:RIBERO, SIERRA E (APN)
Entity type:Individual
Prefix:
First Name:SIERRA
Middle Name:E
Last Name:RIBERO
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:SIERRA
Other - Middle Name:E
Other - Last Name:BUSHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:2875 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-3501
Mailing Address - Country:US
Mailing Address - Phone:773-484-1000
Mailing Address - Fax:
Practice Address - Street 1:2875 W 19TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-3501
Practice Address - Country:US
Practice Address - Phone:773-484-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010087367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife