Healthcare Provider Details

I. General information

NPI: 1831456680
Provider Name (Legal Business Name): SUZANNE MARTHA FLOOD R.N, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 W CHICAGO AVE
CHICAGO IL
60622-4519
US

IV. Provider business mailing address

741 FOREST AVE
EVANSTON IL
60202-2503
US

V. Phone/Fax

Practice location:
  • Phone: 773-395-9901
  • Fax:
Mailing address:
  • Phone: 847-475-7077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209002696
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: