Provider Demographics
NPI:1215641352
Name:SA, GLORIA A (APN-CNP)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:A
Last Name:SA
Suffix:
Gender:F
Credentials:APN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 PARK AVE W STE 2850
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-2558
Mailing Address - Country:US
Mailing Address - Phone:847-657-1900
Mailing Address - Fax:847-733-5041
Practice Address - Street 1:757 PARK AVE W STE 2850
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-2558
Practice Address - Country:US
Practice Address - Phone:847-657-1900
Practice Address - Fax:847-733-5041
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.026653363LF0000X
IL209026653363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily