Individual
SUSAN ADAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, APN
Contact information
Practice address
1600 E JACKSON ST, MACOMB, IL 61455-2530
(309) 833-4101
Mailing address
PO BOX 1179, MACOMB, IL 61455-5579
(309) 833-4101
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209004534
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
148952
MEDICARE PART A
IL
Enumeration date
06/22/2005
Last updated
02/16/2015
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