Provider Demographics
NPI:1407025133
Name:KURIEN, SUDHA (NP)
Entity Type:Individual
Prefix:
First Name:SUDHA
Middle Name:
Last Name:KURIEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUDHA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1875 W DEMPSTER ST STE 525
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1130
Mailing Address - Country:US
Mailing Address - Phone:847-698-5500
Mailing Address - Fax:847-698-5517
Practice Address - Street 1:1875 W DEMPSTER ST STE 525
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1130
Practice Address - Country:US
Practice Address - Phone:847-698-5500
Practice Address - Fax:847-698-5517
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002248363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health