Provider Demographics
NPI:1124058359
Name:SIT, PHYLLIS MARIE (APN, CRNA)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:MARIE
Last Name:SIT
Suffix:
Gender:F
Credentials:APN, CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 BARRYPOINT RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-2840
Mailing Address - Country:US
Mailing Address - Phone:708-447-7440
Mailing Address - Fax:312-864-9600
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:ROOM 3675
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-3215
Practice Address - Fax:312-864-9600
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209000411367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered