Provider Demographics
NPI:1265667547
Name:CORBRIDGE, SUSAN JOAN (PHD, APN)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:JOAN
Last Name:CORBRIDGE
Suffix:
Gender:F
Credentials:PHD, APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 COMMONS RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2488
Mailing Address - Country:US
Mailing Address - Phone:630-369-8896
Mailing Address - Fax:
Practice Address - Street 1:845 S DAMEN AVE # MC802
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3727
Practice Address - Country:US
Practice Address - Phone:312-413-3457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.001887363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care