Provider Demographics
NPI:1073929352
Name:NEAULT, SARAH H (BSN, MS)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:H
Last Name:NEAULT
Suffix:
Gender:F
Credentials:BSN, MS
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:K
Other - Last Name:HUDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:2318 N OAKLEY AVE
Mailing Address - Street 2:LOWER UNIT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-3238
Mailing Address - Country:US
Mailing Address - Phone:616-915-8664
Mailing Address - Fax:
Practice Address - Street 1:225 E CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2991
Practice Address - Country:US
Practice Address - Phone:616-915-8664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012780363LP0200X
NY670105163WP0200X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program