Individual
NICHOLE SUZANNE SUCKOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
912 N HENRIETTA ST, EFFINGHAM, IL 62401-1788
(217) 342-3337
(217) 342-3338
Mailing address
PO BOX 784, EFFINGHAM, IL 62401-0784
(217) 342-3337
(217) 342-3338
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002146
IL
Other
Enumeration date
09/21/2005
Last updated
11/02/2011
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