Healthcare Provider Details

I. General information

NPI: 1972893865
Provider Name (Legal Business Name): CAROL SUE VICTOR APN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. CAROL SUE RITZMAN

II. Dates (important events)

Enumeration Date: 04/12/2011
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 DEMPSTER ST T09303
PARK RIDGE IL
60068-1143
US

IV. Provider business mailing address

1775 DEMPSTER ST T09303
PARK RIDGE IL
60068-1143
US

V. Phone/Fax

Practice location:
  • Phone: 847-723-7408
  • Fax: 847-723-4690
Mailing address:
  • Phone: 847-723-7408
  • Fax: 847-723-4690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number209008418
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: