1972893865 NPI number — MRS. CAROL SUE VICTOR APN, CDE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972893865 NPI number — MRS. CAROL SUE VICTOR APN, CDE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VICTOR
Provider First Name:
CAROL
Provider Middle Name:
SUE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APN, CDE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RITZMAN
Provider Other First Name:
CAROL
Provider Other Middle Name:
SUE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972893865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1775 DEMPSTER ST
Provider Second Line Business Mailing Address:
T09303
Provider Business Mailing Address City Name:
PARK RIDGE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60068-1143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-723-7408
Provider Business Mailing Address Fax Number:
847-723-4690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1775 DEMPSTER ST
Provider Second Line Business Practice Location Address:
T09303
Provider Business Practice Location Address City Name:
PARK RIDGE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60068-1143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-723-7408
Provider Business Practice Location Address Fax Number:
847-723-4690
Provider Enumeration Date:
04/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SA2200X , with the licence number:  209008418 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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