Individual
GRACYKUTTY T SEBASTIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
4201 W MEDICAL CENTER DR, MCHENRY, IL 60050-8409
(815) 759-4323
(815) 759-4948
Mailing address
4201 W MEDICAL CENTER DR, MCHENRY, IL 60050-8409
(815) 759-4323
(815) 759-4948
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-007338
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209007338
STATE LICENSE
IL
Enumeration date
02/23/2011
Last updated
04/21/2021
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