Provider Demographics
NPI:1841468139
Name:HUSSUSSIAN, MIMI NOELLE (APN)
Entity type:Individual
Prefix:MISS
First Name:MIMI
Middle Name:NOELLE
Last Name:HUSSUSSIAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CHILDREN'S MEMORIAL HOSPITAL, 2300CHILDREN'S PLAZA
Mailing Address - Street 2:BOX #253
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-880-3940
Mailing Address - Fax:
Practice Address - Street 1:CHILDREN'S MEMORIAL HOSPITAL, 2300CHILDREN'S PLAZA
Practice Address - Street 2:BOX #253
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-880-3940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal