Provider Demographics
NPI:1841436664
Name:BUCK, SUSAN MARIE (MS, APN, CPNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:MARIE
Last Name:BUCK
Suffix:
Gender:F
Credentials:MS, APN, CPNP
Other - Prefix:MISS
Other - First Name:SUSAN
Other - Middle Name:MARIE
Other - Last Name:BERTNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1222
Mailing Address - Country:US
Mailing Address - Phone:630-933-2942
Mailing Address - Fax:630-933-6685
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1222
Practice Address - Country:US
Practice Address - Phone:630-933-2942
Practice Address - Fax:630-933-6685
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041283981163WP0200X
IL209004032363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics