Super, Mary T

Super, Mary T is an individual health care provider with primary practice located at 4440 W 95Th St , Oak Lawn IL 60453-2600. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Super, Mary T can be contacted via phone (708) 684-8000.

Contact Information

Primary practice address
4440 W 95Th St Oak Lawn IL 60453-2600
Phone: (708) 684-8000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 209004357 Illinois

Profile Details

NPI number 1215176581
LBN Legal business name Super, Mary T
Credentials Advanced Practice Nurse (APN)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 11th, 2009
Last updated Jul 31st, 2012 - about 14 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 1215176581 NPPES
Illinois Other 203981003 MEDICARE PTAN
Illinois Other 203981 MEDICARE PTAN

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