Suzanne D Tietjen
Nurse Practitioner - Neonatal
530 Ne Glen Oak Ave
Peoria
, Illinois 61637-0001
Suzanne D Tietjen
Nurse Practitioner - Neonatal
530 Ne Glen Oak Ave
Peoria
, Illinois 61637-0001
(309) 671-8513
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About
Features
Specialties
- Nurse Practitioner - Neonatal
Languages spoken
- English
Location
First Address
- Suzanne D Tietjen
- Po Box 1649
- Peoria, IL
- Zip : 61656-1649
- Fax : (309) 671-8513
- Phone : (309) 671-8504
Second Address
- Suzanne D Tietjen
- 530 Ne Glen Oak Ave
- Peoria, IL
- Zip : 61637-0001
- Phone : (309) 655-2974
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LN0000X | Nurse Practitioner - Neonatal | 041-261586 | IL |
National Provider Identifier
| NPI | 1013173335 |
|---|---|
| Provider Name | Suzanne D Tietjen |
| First Address | Peoria, IL 61656-1649 |
| Second Address | Peoria, IL 61637-0001 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 06/08/2008 |
| Last Update Date | 18/08/2008 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.