1144286840 NPI number — MS. SUZANNE H STILWELL MS, CGC

Table of content: MS. SUZANNE H STILWELL MS, CGC (NPI 1144286840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144286840 NPI number — MS. SUZANNE H STILWELL MS, CGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STILWELL
Provider First Name:
SUZANNE
Provider Middle Name:
H
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STILWELL
Provider Other First Name:
SUZIE
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, CGC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1144286840
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6083 BUTTERCUP LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKFORD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61108-8111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-227-9363
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 N ROCKTON AVE
Provider Second Line Business Practice Location Address:
DEPT OF MEDICAL GENETICS, ROCKFORD MEMORIAL HOSPITAL
Provider Business Practice Location Address City Name:
ROCKFORD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61103-3655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-971-5069
Provider Business Practice Location Address Fax Number:
815-968-7830
Provider Enumeration Date:
04/22/2006

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: 170300000X , with the licence number:  96235 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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