Individual
SAMANTHA JERUSAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2418 W DIVISION ST, CHICAGO, IL 60622-2940
(312) 666-3494
Mailing address
2418 W DIVISION ST, CHICAGO, IL 60622-2940
(312) 666-3494
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
501051
OH
363LP0200X
Pediatric Nurse Practitioner
Primary
209.028195
IL
Other
Enumeration date
03/22/2023
Last updated
09/05/2023
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