Provider Demographics
NPI:1770028128
Name:CARROLL, SUZANNE (FNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3249 N LAKEWOOD AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3201
Mailing Address - Country:US
Mailing Address - Phone:847-989-9932
Mailing Address - Fax:
Practice Address - Street 1:3249 N LAKEWOOD AVE
Practice Address - Street 2:APT 3
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3201
Practice Address - Country:US
Practice Address - Phone:847-989-9932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.015338363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily