Provider Demographics
NPI:1184834244
Name:RYAN, SUSAN DAWN (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:DAWN
Last Name:RYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:DAWN
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:201 E HURON ST
Mailing Address - Street 2:GALTER SUITE 11-140
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3197
Mailing Address - Country:US
Mailing Address - Phone:312-926-2912
Mailing Address - Fax:312-926-7464
Practice Address - Street 1:675 N SAINT CLAIR ST
Practice Address - Street 2:GALTER SUITE 19-100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5975
Practice Address - Country:US
Practice Address - Phone:312-926-2912
Practice Address - Fax:312-926-7464
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004324364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care