Provider Demographics
NPI:1740406610
Name:DIBBLEE, SUSAN M (PA-C)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:DIBBLEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:37W002 S MOOSEHEART ROAD
Mailing Address - Street 2:
Mailing Address - City:MOOSEHEART
Mailing Address - State:IL
Mailing Address - Zip Code:60539
Mailing Address - Country:US
Mailing Address - Phone:630-264-2684
Mailing Address - Fax:630-264-2848
Practice Address - Street 1:37W002 S MOOSEHEART ROAD
Practice Address - Street 2:
Practice Address - City:MOOSEHEART
Practice Address - State:IL
Practice Address - Zip Code:60539
Practice Address - Country:US
Practice Address - Phone:630-264-2684
Practice Address - Fax:630-264-2848
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant