Provider Demographics
NPI:1972893865
Name:VICTOR, CAROL SUE (APN, CDE)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:SUE
Last Name:VICTOR
Suffix:
Gender:F
Credentials:APN, CDE
Other - Prefix:MRS
Other - First Name:CAROL
Other - Middle Name:SUE
Other - Last Name:RITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1775 DEMPSTER ST
Mailing Address - Street 2:T09303
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1143
Mailing Address - Country:US
Mailing Address - Phone:847-723-7408
Mailing Address - Fax:847-723-4690
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:T09303
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-7408
Practice Address - Fax:847-723-4690
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008418364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health