Individual
MISS KAREN SUSANNE TABOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3001 GREEN BAY RD, NORTH CHICAGO, IL 60064-3048
(618) 997-5311
Mailing address
3001 GREEN BAY RD, NORTH CHICAGO, IL 60064-3048
(618) 997-5311
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002666
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085-002666
ILLINOIS STATE LICENSE
IL
01
—
1002128
AAPA
—
01
—
1055175
NCCPA LICENSE
—
Enumeration date
06/28/2006
Last updated
07/10/2013
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