Provider Demographics
NPI:1871219840
Name:NUSSBAUM, SARAH R (PNP-CP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:R
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:PNP-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3104 W JEROME ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-1143
Mailing Address - Country:US
Mailing Address - Phone:773-981-3347
Mailing Address - Fax:
Practice Address - Street 1:4709 GOLF RD STE 900
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1244
Practice Address - Country:US
Practice Address - Phone:847-676-5394
Practice Address - Fax:773-679-7183
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026058363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics