Healthcare Provider Details

I. General information

NPI: 1497584775
Provider Name (Legal Business Name): SUSAN KIM LAADIMI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 ROLLINGRIDGE RD STE 300
NAPERVILLE IL
60564-4235
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-5800
  • Fax: 630-646-5858
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.030108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: