NPI 1013173335

Suzanne D Tietjen, BSNNNP

Practitioner Neonatal Nurse Practitioner Peoria, IL

Practice location

Address: 530 NE Glen Oak Ave, Peoria, IL 61637-0001
Phone: (309) 655-2974
Mailing address: PO Box 1649, Peoria, IL 61656-1649

Registered specialties

Neonatal Nurse Practitioner Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363LN0000X Licence 041-261586 (IL)

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Registry record

NPI: 1013173335
Entity type: Individual
Sex (as registered): Female
NPI issued: 6 Aug 2008
Record last updated: 18 Aug 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.