GRACYKUTTY T SEBASTIAN (NPI# 1629375985) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1629375985 |
| Entity Type | Individual |
| Full Name | GRACYKUTTY T SEBASTIAN |
| Credential | CNP |
| Practice Address |
4309 W Medical Center Dr Ste A102 Mchenry IL 60050 |
| Mailing Address |
4309 W Medical Center Dr Ste A102 Mchenry IL 60050-8436 |
| Practice Telephone | (815) 338-6600 |
| Mailing Telephone | 8153386600 |
| Enumeration Date | 2011-02-23 |
| Last Update Date | 2018-06-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 209-007338 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 364SA2200X |
Clinical Nurse Specialist Specialization: Adult Health |
209007338 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | STATE LICENSE | 209007338 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2971 W Algonquin Rd, Suite 104, Algonquin, IL 601029406 | 8476587693 | 8476587986 |
| Street Address |
4309 W MEDICAL CENTER DR STE A102 |
| City | MCHENRY |
| State | IL |
| Zip Code | 60050 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073591533 | Stephen Ross Dreznin | Internal Medicine | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2006-01-05 |
| 1861836033 | George Nithin Thomas | Family Medicine | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2013-04-18 |
| 1457794794 | Imran Ali Osmani | Internal Medicine | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2013-04-16 |
| 1407134661 | Maryana Yaremko | Internal Medicine | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2011-07-21 |
| 1891086906 | Kun Wang | Hospitalist | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2011-04-22 |
| 1609100429 | Muhammad Hammad Tahir | Internal Medicine | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2009-09-25 |
| 1508093527 | Uwa Kalu | Family Medicine | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2009-06-17 |
| 1265679278 | Ayesha Masood | Internal Medicine | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2009-01-13 |
| 1245493659 | Maryna Shayuk | Internal Medicine | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2008-07-07 |
| 1063675619 | Bhanu Prasad Sankineni | Internal Medicine | 4309 W Medical Center Dr Ste A102, Mchenry, IL 60050-8436 | 2008-07-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932728003 | Tco Jv, LLC | Skilled Nursing Facility | 550 Ridgeview Drive, Mchenry, IL 60050 | 2020-04-09 |
| 1992274971 | Lisa Luedtke | Counselor | 5342 West Elm Street, Mchenry, IL 60050 | 2018-11-19 |
| 1013402825 | Fox Ridge Medical Associates, LLC | Internal Medicine | 3633 Municipal Dr, Mchenry, IL 60050 | 2018-06-25 |
| 1700387065 | Richard Stacy Birmantas | Speech-Language Pathologist | 6515 West Route 120, Mchenry, IL 60050 | 2018-02-22 |
| 1659888774 | Kathleen Mather | Speech-Language Pathologist | 3502 Washington St, Mchenry, IL 60050 | 2018-01-10 |
| 1891205605 | Delorean Mckinney | Psychologist | 4031 Dayton Ave, Mchenry, IL 60050 | 2017-10-06 |
| 1851810741 | Diana Park | Pharmacist | 2253 N. Richmond Rd., Mchenry, IL 60050 | 2017-09-12 |
| 1063931921 | Lauren M Young | Counselor | 4031 W. Dayton Street, Mchenery, IL 60050 | 2017-09-12 |
| 1376086264 | Elizabeth Kathleen Zacher | Social Worker | 4100 W Dayton Street, Mchenry, IL 60050 | 2016-11-23 |
| 1700332491 | Jasmine Elias | Social Worker | 4031 Dayton St, Mchenry, IL 60050 | 2016-09-01 |
| Find all providers in zip 60050 | ||||
| Taxonomy Code | 364SA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194123679 | Judi Kittle Forner | Clinical Nurse Specialist | 4309 W Medical Center Dr Ste A200, Mchenry, IL 60050 | 2014-12-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942668355 | Joannne Geralyn Delany | Clinical Nurse Specialist | 13133 Meadowview Ln, Homer Glen, IL 60491-9155 | 2016-02-01 |
| 1033559802 | Shannon L Laesch | Clinical Nurse Specialist | 2005 Jacobssen Dr Ste A, Normal, IL 61761-6288 | 2013-06-26 |
| 1427323898 | Kara Michelle Aalfs | Clinical Nurse Specialist | 6n910 Gilmore Dr, Saint Charles, IL 60175-8314 | 2012-03-18 |
| 1528351962 | Kristi Kae Williams | Clinical Nurse Specialist | 530 Ne Glenoak Avenue Pob Suite 108, Peoria, IL 61603-3117 | 2011-05-18 |
| 1427356336 | Lissa J Diefendorf | Clinical Nurse Specialist | 403 W Corrington Ave, Peoria, IL 61604-2803 | 2011-03-02 |
| 1326354358 | Sheila A Harmon | Clinical Nurse Specialist | 654 East 47th St, Access Booker Family Health Center, Chicago, IL 60653-4224 | 2010-08-27 |
| 1689283723 | Michelle Marie Lovsey | Clinical Nurse Specialist | 1 Saint Anthonys Way, Alton, IL 62002-4568 | 2020-07-24 |
| 1053942318 | Mary Sue Dailey | Clinical Nurse Specialist | 3815 Highland Ave, Downers Grove, IL 60515-1500 | 2020-01-27 |
| 1316448947 | Cheryl A Pahl | Clinical Nurse Specialist | 801 S Milwaukee Ave, Libertyville, IL 60048-3204 | 2018-02-28 |
| 1144728155 | Euphemia M Connell | Clinical Nurse Specialist | 5841 S Maryland Ave, Chicago, IL 60637-1443 | 2018-01-24 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on GRACYKUTTY T SEBASTIAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.