Provider Demographics
NPI:1912917600
Name:BRAUN, SUSAN C (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:C
Last Name:BRAUN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 S. DAMEN AVE.
Mailing Address - Street 2:COLLEGE OF NURSING SUITE 954
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-996-7996
Mailing Address - Fax:312-996-7725
Practice Address - Street 1:4219 N. LINCOLN AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:773-435-0117
Practice Address - Fax:773-435-0119
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0040030709OtherBC/BS
ILQ63007Medicare UPIN
IL0040030709OtherBC/BS