Provider Demographics
NPI:1467746636
Name:HAMPSON, SUSAN MARIE (FNP-BC; APRN)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:MARIE
Last Name:HAMPSON
Suffix:
Gender:F
Credentials:FNP-BC; APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 W 103RD ST
Mailing Address - Street 2:SCHOOL OF NURSING SAINT XAVIER UNIVERSITY
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-3105
Mailing Address - Country:US
Mailing Address - Phone:773-298-3000
Mailing Address - Fax:773-298-3704
Practice Address - Street 1:3700 W 103RD ST
Practice Address - Street 2:HEALTH CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3105
Practice Address - Country:US
Practice Address - Phone:773-298-3712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-06
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.003489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily