Provider Demographics
NPI:1659385722
Name:O'NEILL, SUSAN C (NP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:C
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 S WASHINGTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60565-2496
Mailing Address - Country:US
Mailing Address - Phone:630-527-0716
Mailing Address - Fax:630-420-1757
Practice Address - Street 1:1795 S WASHINGTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-2496
Practice Address - Country:US
Practice Address - Phone:630-527-0716
Practice Address - Fax:630-420-1757
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-003780363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01636236OtherBCBS
IL01636236OtherBCBS
ILK30856Medicare PIN
IL206385Medicare ID - Type UnspecifiedPROVIDER NUMBER