Provider Demographics
NPI:1447566435
Name:MCGINNES, SUE S (APN, CNP)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:S
Last Name:MCGINNES
Suffix:
Gender:F
Credentials:APN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17419 OLD COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61705-5920
Mailing Address - Country:US
Mailing Address - Phone:309-662-3113
Mailing Address - Fax:
Practice Address - Street 1:902 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-3510
Practice Address - Country:US
Practice Address - Phone:309-888-5531
Practice Address - Fax:309-888-5530
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001665363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily