MEDICARE: MRS. MEGAN BAIRD SUTTON ACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	209007073	IL

General Provider Information

NPI Number	:	1467746180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN BAIRD SUTTON ACNP

Provider Business Mailing Address
First Line	:	1735 W DIVISION ST
Second Line	:	APT 201
City	:	CHICAGO
State	:	IL
Zip	:	60622-4228
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 W DIVISION ST
Second Line	:	APARTMENT 201
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	914-391-0535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	05/31/2011

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