Individual
SUE M PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
225 E CHICAGO AVE # 19, CHICAGO, IL 60611-2991
(312) 227-5157
(312) 227-9730
Mailing address
225 E CHICAGO AVE # 19, CHICAGO, IL 60611-2991
(312) 227-5157
(312) 227-9730
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
209.007061041.336475
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578700522
—
IL
05
—
1801058086
—
IL
Enumeration date
01/13/2009
Last updated
02/04/2019
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