Basic Information
| Provider Information | |||||||||
| NPI: | 1750497467 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUTICH | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9125 S PULASKI RD | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608051441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084227715 | ||||||||
| FaxNumber: | 7084227816 | ||||||||
| Practice Location | |||||||||
| Address1: | 9125 S PULASKI RD | ||||||||
| Address2: | |||||||||
| City: | EVERGREEN PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 608051441 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084227715 | ||||||||
| FaxNumber: | 7084227816 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SM0705X | 209-003060 | IL | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Medical-Surgical | 364SA2200X | 209-003060 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.