Individual
MRS. SUSAN M. FAZEKAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FPN
Contact information
Practice address
259 PAUL REVERE DR, CHESTERTON, IN 46304-9371
(219) 405-6779
Mailing address
259 PAUL REVERE DR, CHESTERTON, IN 46304-9371
(219) 405-6779
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71000803A
IN
Other
Enumeration date
09/22/2005
Last updated
04/12/2021
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