Provider Demographics
NPI:1356340608
Name:STEIN, SUZANNE (CRNA)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 HARLEM ROAD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-2754
Mailing Address - Country:US
Mailing Address - Phone:815-877-4848
Mailing Address - Fax:815-654-5342
Practice Address - Street 1:2202 HARLEM ROAD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-2754
Practice Address - Country:US
Practice Address - Phone:815-877-4848
Practice Address - Fax:815-654-5342
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004671363L00000X
IAD177606367500000X
IN28231827A367500000X
IL209-006499367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04532206OtherBLUE CROSS BLUE SHIELD
IL04532206OtherBLUE CROSS BLUE SHIELD
ILQ27396Medicare UPIN
IL209897Medicare ID - Type UnspecifiedGROUP LOCALITY 15
IL04532206OtherBLUE CROSS BLUE SHIELD
IL$$$$$$$$$001Medicaid
IL209896Medicare ID - Type UnspecifiedGROUP LOCALITY 99
ILK11842Medicare ID - Type UnspecifiedLOCALITY 99