Provider Demographics
NPI:1063813194
Name:PHELAN, SUSAN M (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:PHELAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:M
Other - Last Name:SALEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REGISTERED NURSE
Mailing Address - Street 1:1010 N HOOKER ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-4549
Mailing Address - Country:US
Mailing Address - Phone:312-943-3600
Mailing Address - Fax:866-410-9192
Practice Address - Street 1:299 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:WOOD DALE
Practice Address - State:IL
Practice Address - Zip Code:60191-1512
Practice Address - Country:US
Practice Address - Phone:773-519-0896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041305029163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WH0200XNursing Service ProvidersRegistered NurseHome Health