Individual
SUSAN M METTILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2805 N KNOXVILLE AVE, PEORIA, IL 61604-2869
(309) 624-9400
(309) 624-2280
Mailing address
2805 N KNOXVILLE AVE, PEORIA, IL 61604-2869
(309) 624-9400
(309) 624-2280
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
208846
MEDICARE GROUP #
IL
01
—
809840
MEDICARE - GROUP #
IL
Enumeration date
06/11/2006
Last updated
02/19/2008
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