Provider Demographics
NPI:1710314067
Name:BARTLETT-AMMANN, SUSAN (RN, BSN,IBCLC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BARTLETT-AMMANN
Suffix:
Gender:F
Credentials:RN, BSN,IBCLC
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:YE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN,BSN,IBCLC
Mailing Address - Street 1:532 WESLEY AVE
Mailing Address - Street 2:EAST UNIT
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2104
Mailing Address - Country:US
Mailing Address - Phone:847-863-7475
Mailing Address - Fax:
Practice Address - Street 1:532 WESLEY AVE
Practice Address - Street 2:EAST UNIT
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2104
Practice Address - Country:US
Practice Address - Phone:847-863-7475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.314449163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant