Provider Demographics
NPI:1932179751
Name:BODE, SHARON M (FNP)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:BODE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 N RANDALL RD
Mailing Address - Street 2:STE 201
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-695-3168
Mailing Address - Fax:847-695-4289
Practice Address - Street 1:1435 N RANDALL RD
Practice Address - Street 2:STE 201
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-695-3168
Practice Address - Fax:847-695-4289
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.007890363LF0000X
MO117826363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07100261Medicaid
MO000081162Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
IL07100261Medicaid