1477580900 NPI number — MS. MAY M. SUNDBERG MSN,APRN,BC

Table of content: MS. MAY M. SUNDBERG MSN,APRN,BC (NPI 1477580900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477580900 NPI number — MS. MAY M. SUNDBERG MSN,APRN,BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUNDBERG
Provider First Name:
MAY
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSN,APRN,BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477580900
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 N LAKE SHORE DR
Provider Second Line Business Mailing Address:
#2415
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60613-4684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-327-8620
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5TH AVENUE AND ROOSEVELT ROAD
Provider Second Line Business Practice Location Address:
(116A3)
Provider Business Practice Location Address City Name:
HINES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-202-3619
Provider Business Practice Location Address Fax Number:
708-202-2108
Provider Enumeration Date:
06/28/2006

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: 364SP0809X , 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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