Provider Demographics
NPI:1336350461
Name:NEVIN, SUSAN ANN (MED)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ANN
Last Name:NEVIN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15660 TORREY PINES DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-7754
Mailing Address - Country:US
Mailing Address - Phone:708-349-8208
Mailing Address - Fax:708-349-8928
Practice Address - Street 1:15660 TORREY PINES DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-7754
Practice Address - Country:US
Practice Address - Phone:708-349-8208
Practice Address - Fax:708-349-8928
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist