Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | IL |
NPI | 1043421704 |
---|---|
Provider Name | Susan M. Bednar |
First Address | Evanston, IL 60201-1718 |
Second Address | Evanston, IL 60201-1718 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
209-00873 | IL STATE LIC (01) | IL |