Provider Demographics
NPI:1952317786
Name:MULCRONE, SANDRA LEE (CNM,APRN,MS)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:MULCRONE
Suffix:
Gender:F
Credentials:CNM,APRN,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 WEST AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-4508
Mailing Address - Country:US
Mailing Address - Phone:708-590-5304
Mailing Address - Fax:708-590-5308
Practice Address - Street 1:15300 WEST AVE STE 120
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-4508
Practice Address - Country:US
Practice Address - Phone:708-590-5304
Practice Address - Fax:708-590-5308
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001535367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL41.254942Medicaid