Individual
SUZANNE D TIETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN, NNP
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-2974
Mailing address
PO BOX 1649, PEORIA, IL 61656-1649
(309) 671-8504
(309) 671-8513
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
041-261586
IL
Other
Enumeration date
08/06/2008
Last updated
08/18/2008
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