Individual
SUSAN L KOEPPE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.N.P.
Contact information
Practice address
1051 W US ROUTE 6, SUITE 100, MORRIS, IL 60450-3349
(815) 942-4875
(815) 942-5046
Mailing address
1051 W US ROUTE 6, SUITE 100, MORRIS, IL 60450-3349
(815) 942-4875
(815) 942-5046
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209004405
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0739010001
MEDICARE NSC
IL
01
—
0739010005
MEDICARE NSC
IL
01
—
0739010006
MEDICARE NSC
IL
01
—
0739010008
MEDICARE NSC
IL
05
—
209004405
—
IL
01
—
CL7476
RAILROAD MEDICARE GROUP #
IL
01
—
P00294919
RR MEDICARE
IL
Enumeration date
08/05/2006
Last updated
07/27/2009
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