Provider Demographics
NPI:1154748648
Name:HUCHEL, SUSAN (FNP)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:
Last Name:HUCHEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FAIRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:IL
Mailing Address - Zip Code:62294-2247
Mailing Address - Country:US
Mailing Address - Phone:618-667-9785
Mailing Address - Fax:
Practice Address - Street 1:129 FAIRINGTON DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2247
Practice Address - Country:US
Practice Address - Phone:618-667-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-24
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011405363LF0000X
MO2014004552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily