Provider Demographics
NPI:1073598991
Name:RYSSMANN, LOUISE MARGARET (PNP)
Entity Type:Individual
Prefix:MS
First Name:LOUISE
Middle Name:MARGARET
Last Name:RYSSMANN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:PROF
Other - First Name:LOUISE
Other - Middle Name:MARGARET
Other - Last Name:RYSSMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-0164
Mailing Address - Country:US
Mailing Address - Phone:847-615-1037
Mailing Address - Fax:847-688-7475
Practice Address - Street 1:3001 6TH ST
Practice Address - Street 2:
Practice Address - City:GREAT LAKES
Practice Address - State:IL
Practice Address - Zip Code:60088-2833
Practice Address - Country:US
Practice Address - Phone:847-688-4560
Practice Address - Fax:847-688-7475
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics