MRS. SUSAN M DAVIS, ND, FNP-BC - NPI NUMBER 1609145234

Summary

Provider Name: MRS. SUSAN M DAVIS, ND, FNP-BC

NPI Number: 1609145234

Clasification: Nurse Practitioner (363LF0000X)

Specialization: Family

Organization: HOME PSYCH SERVICES, P.C.

Address:
755 E BOUGHTON RD
BOLINGBROOK, IL
ZIP 60440

Phone Number: (630) 783-2207



Detailed Information

MRS. Susan M Davis, ND, FNP-BC is a family nurse practitioner in Bolingbrook, IL with 18 years of experience. The assigned NPI number for this provider is 1609145234 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

755 E BOUGHTON RD
BOLINGBROOK, IL
ZIP 60440-250
Phone: (630) 783-2207

The enumeration date for this NPI number is 12/28/2011 and was last updated on 12/28/2011.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 363LF0000X Nurse Practitioner Family 209004410 IL Yes

NPI Record

No. Field Name Field Value
1 NPI 1609145234
2 Entity Type Code 1
3 Provider Last Name Legal Name DAVIS
4 Provider First Name SUSAN
5 Provider Middle Name M
6 Provider Name Prefix Text MRS.
7 Provider Credential Text ND, FNP-BC
8 Provider First Line Business Practice Location Address 755 E BOUGHTON RD
9 Provider Business Practice Location Address City Name BOLINGBROOK
10 Provider Business Practice Location Address State Name IL
11 Provider Business Practice Location Address Postal Code 604402250
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 6307832207
14 Provider Enumeration Date 12/28/2011
15 Last Update Date 12/28/2011
16 Provider Gender Code F
17 Healthcare Provider Taxonomy Code 1 363LF0000X
18 Provider License Number 1 209004410
19 Provider License Number State Code 1 IL
20 Healthcare Provider Primary Taxonomy Switch 1 Y
21 Is Sole Proprietor N

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This page was last updated on: 10/12/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.