Dintzis, Susannah Nicholson

Dintzis, Susannah Nicholson is an individual health care provider with primary practice located at 2321 N Wisconsin Ave , Peoria IL 61603-5613. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Dintzis, Susannah Nicholson can be contacted via phone (309) 680-7600.

Contact Information

Primary practice address
2321 N Wisconsin Ave Peoria IL 61603-5613
Phone: (309) 680-7600
Fax: (309) 681-4681
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 041283996 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 209-002547 Illinois

Profile Details

NPI number 1902848153
LBN Legal business name Dintzis, Susannah Nicholson
Credentials Family Nurse Practitioner (FNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 12th, 2006
Last updated Feb 18th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902848153 NPPES
Illinois Other 7215059 BCBS PPO

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