Provider Demographics
NPI:1538173240
Name:KURTENBACH, SUSAN K (APN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:KURTENBACH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 LYMAN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-2225
Mailing Address - Country:US
Mailing Address - Phone:708-217-7567
Mailing Address - Fax:773-521-9543
Practice Address - Street 1:4015 N ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2593
Practice Address - Country:US
Practice Address - Phone:773-404-0447
Practice Address - Fax:773-404-2484
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL309-000686363LF0000X
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily