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Sage Jacklyn Vanantwerp, DMD
Student in an Organized Health Care Education/Training Program in Maywood, Illinois
NPI 1265963359

Sage Jacklyn Vanantwerp is a Student in an Organized Health Care Education/Training Program based in Gainesville, IL. Sage Jacklyn Vanantwerp practices in Maywood, IL and has the professional credentials of DMD. The NPI Number for Sage Jacklyn Vanantwerp is 1265963359 and holds a License No. (Illinois).

The current practice location address for Sage Jacklyn Vanantwerp is 2160 S 1St Ave, Maywood, IL and can be reached out via phone at 708-327-3041.

Location: 2160 S 1St Ave, Maywood, IL, 32608-8002
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1265963359
Provider Name
Sage Jacklyn Vanantwerp
Credential
DMD
Provider Entity Type
Individual
Gender
Female
Address
2160 S 1St Ave, Maywood, IL, 32608-8002
Phone Number
708-327-3041
Fax Number
Provider Enumeration Date
03/21/2017
Last Update Date
03/09/2024
institution
Provider Business Practice Location Address Details
Address
2160 S 1St Ave
City
Maywood
State
Illinois
Zip
60153-3328
Phone Number
708-327-3041
Fax Number
person
Provider Business Mailing Address Details
Address
2160 S 1St Ave
City
Maywood
State
Illinois
Zip
60153-3328
Phone Number
708-327-3041
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
()
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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