Susan Wilde, CNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

Practice address

4309 W Medical Center Dr
B310
McHenry, IL 60050-8419

Phone

(815) 344-0900

Fax

(815) 344-8957

NPI assigned

May 8, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lurie Children'S Medical Group, LLC

  • Pediatrics Physician
  • Chicago, IL
  • NPI 1992758544
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1188518400000",
    "number": "1144279100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3707 DOTY RD",
            "address_2": "SUITE G",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987530",
            "telephone_number": "815-206-1067",
            "fax_number": "815-206-2804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4309 W MEDICAL CENTER DR",
            "address_2": "B310",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600508419",
            "telephone_number": "815-344-0900",
            "fax_number": "815-344-8957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILDE",
        "first_name": "SUSAN",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-08",
        "last_updated": "2007-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jodi Lynn Wickenkamp, M.S.-CCC
• Helen Wiechertvestergren
• Abigail Lynn Wikman
• Julia C Wikman
• Tina Wikman
• Wildfire Counseling and Wellness, PLLC
• Joseph Michael Wilett
• Michele Marie Wilkinson, APRN, CNP
• Sally Wilkinson
• Calysta Will, LPC

• Pediatric Nurse Practitioner in McHenry, IL
• Providers in McHenry, IL by specialty
• Pediatric Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.