1073598991 NPI number — MS. LOUISE MARGARET RYSSMANN PNP

Table of content: MS. LOUISE MARGARET RYSSMANN PNP (NPI 1073598991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073598991 NPI number — MS. LOUISE MARGARET RYSSMANN PNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RYSSMANN
Provider First Name:
LOUISE
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RYSSMANN
Provider Other First Name:
LOUISE
Provider Other Middle Name:
MARGARET
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1073598991
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:
PO BOX 164
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE BLUFF
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60044-0164
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-615-1037
Provider Business Mailing Address Fax Number:
847-688-7475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREAT LAKES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60088-2833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-688-4560
Provider Business Practice Location Address Fax Number:
847-688-7475
Provider Enumeration Date:
12/13/2005

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: 363LP0200X , 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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