| Doctor Name: | SUZANNE D TIETJEN |
| NPI Number: | 1013173335 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BSN, NNP |
| License Number: | 041-261586 |
| Business Practice Address: | 530 Ne Glen Oak Ave Peoria, IL - 616370001 |
| Business Phone Number: | 3096552974 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1649, PEORIA |
| State: | IL |
| Postal Code: | 616561649 |
| Phone Number: | 3096718504 |
| Fax Number: | 3096718513 |
| NPI Enumeration Date: | 08/06/2008 |
| NPI Last Update Date: | 08/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LN0000X |
| License Number: | 041-261586 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Neonatal |
| Taxonomy Definition: | |