Most Relevant Information
Provider Data
| NPI Number: | 1003808270 |
| Provider Name: | SUSAN A MACK APRN-FPA |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 277000186 |
Most Important Dates
| Enumeration Date: | 08/16/2005 |
| Last Updated: | 12/07/2021 |
Provider Practice Location
514 TEELA LN
DES PLAINES
IL
600161230
Practice Location Phone/Fax
| Phone: | 8476926000 |
| Fax: | 8476926112 |
Provider Mailing Location
514 TEELA LN
DES PLAINES
IL
600161230
Provider Mailing Phone/Fax
| Phone: | 8476926000 |
| Fax: | 8476926112 |