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General NPI Number Information
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NPI Number | 1588182281
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Entity Type | Individual
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Provider Name | SUSANNE A RYAN NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 09/01/2017
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 2655 WARRENVILLE RD
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-5555
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Country | US
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Telephone | 708-518-4518
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Fax |
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Provider Business Mailing Address
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Address Line | 17759 67TH CT.
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City | TINLEY PARK
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State | IL
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Zip | 60477-4031
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Country | US
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Telephone | 815-405-6539
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Fax | 847-719-2265
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209016463
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License Number State | IL
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