Healthcare Provider Details

I. General information

NPI: 1841468139
Provider Name (Legal Business Name): MIMI NOELLE HUSSUSSIAN APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2008
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDREN'S MEMORIAL HOSPITAL, 2300CHILDREN'S PLAZA BOX #253
CHICAGO IL
60614
US

IV. Provider business mailing address

CHILDREN'S MEMORIAL HOSPITAL, 2300CHILDREN'S PLAZA BOX #253
CHICAGO IL
60614
US

V. Phone/Fax

Practice location:
  • Phone: 773-880-3940
  • Fax:
Mailing address:
  • Phone: 773-880-3940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: