Provider Demographics
NPI:1275553950
Name:MOYLAN, SUSAN M (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:MOYLAN
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Gender:F
Credentials:NP
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Mailing Address - Street 1:2300 CHILDRENS PLZ
Mailing Address - Street 2:BOX 24
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3394
Mailing Address - Country:US
Mailing Address - Phone:773-880-4428
Mailing Address - Fax:773-880-3339
Practice Address - Street 1:2300 N CHILDRENS PLZ
Practice Address - Street 2:BOX 24
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-3363
Practice Address - Country:US
Practice Address - Phone:773-880-4428
Practice Address - Fax:773-880-3339
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28107622A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209.006870OtherADVANCED PRACTICE NURSE