Provider Demographics
NPI:1740989144
Name:HARTMAN, SUSANNAH CHRISTINE (RN)
Entity type:Individual
Prefix:
First Name:SUSANNAH
Middle Name:CHRISTINE
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1990 BERRY LN
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1648
Mailing Address - Country:US
Mailing Address - Phone:214-250-8823
Mailing Address - Fax:
Practice Address - Street 1:1990 BERRY LN
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1648
Practice Address - Country:US
Practice Address - Phone:214-250-8823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-24
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.515559208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics