Provider Demographics
NPI:1225388176
Name:O'BRIEN, SUSAN G (APN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:G
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 63RD ST STE 103
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-2000
Mailing Address - Country:US
Mailing Address - Phone:630-969-7706
Mailing Address - Fax:630-971-6373
Practice Address - Street 1:412 63RD ST STE 103
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-2000
Practice Address - Country:US
Practice Address - Phone:630-969-7706
Practice Address - Fax:630-971-6373
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041322316163W00000X
IL209005704363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse