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General NPI Number Information
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NPI Number | 1174826119
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Entity Type | Individual
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Provider Name | SUSAN ANN TUCKEY R.N., C.P.N.P.
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Gender | Female
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Dates
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Enumeration Date | 12/14/2010
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Last Update Date | 12/14/2010
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Provider Practice Location Address
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Address Line | 1051 W RAND RD 103
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-2315
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Country | US
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Telephone | 847-259-5900
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Fax | 847-259-4508
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Provider Business Mailing Address
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Address Line | 1051 W RAND RD 103
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-2315
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Country | US
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Telephone | 847-259-5900
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Fax | 847-259-4508
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209.002268041.245460
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.245460
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License Number State | IL
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