Provider Demographics
NPI:1699853069
Name:SUTKOWSKI, JANE ELIZABETH (CNM)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ELIZABETH
Last Name:SUTKOWSKI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MRS
Other - First Name:JANE
Other - Middle Name:ELIZABETH
Other - Last Name:RADULOVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4685
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-4685
Mailing Address - Country:US
Mailing Address - Phone:708-333-3030
Mailing Address - Fax:708-333-6060
Practice Address - Street 1:15620 SOUTH WOOD STREET
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426
Practice Address - Country:US
Practice Address - Phone:708-333-3030
Practice Address - Fax:708-333-6060
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005288367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209005288OtherCERTIFIED NURSE MIDWIFE L