Healthcare Provider Details

I. General information

NPI: 1265345516
Provider Name (Legal Business Name): MARIA SUSANA D DIONIDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 S 5TH AVE
HINES IL
60141-3030
US

IV. Provider business mailing address

241 MAYFAIR LN
SOUTH ELGIN IL
60177-2743
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-8387
  • Fax:
Mailing address:
  • Phone: 630-550-9958
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number41463210
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: