Healthcare Provider Details

I. General information

NPI: 1295112167
Provider Name (Legal Business Name): PATRICIA JOAN SUCHYTA MN, RN, APN,CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

IV. Provider business mailing address

1675 DEMPSTER ST
PARK RIDGE IL
60068-1110
US

V. Phone/Fax

Practice location:
  • Phone: 847-381-9067
  • Fax: 847-723-2325
Mailing address:
  • Phone: 847-381-9067
  • Fax: 847-723-2325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.010342
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: