Provider Demographics
NPI:1982762720
Name:DAVIS, SANDRA L (APN)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 W 75TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-9311
Mailing Address - Country:US
Mailing Address - Phone:630-527-5000
Mailing Address - Fax:630-527-5440
Practice Address - Street 1:1331 W 75TH ST STE 201
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-9311
Practice Address - Country:US
Practice Address - Phone:630-527-5000
Practice Address - Fax:630-529-5440
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001669363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ73600Medicare UPIN
ILK33422Medicare PIN