Provider Demographics
NPI:1285712208
Name:RUSH-DRAKE, SUZETTE (FNP-BC, PSY D)
Entity type:Individual
Prefix:
First Name:SUZETTE
Middle Name:
Last Name:RUSH-DRAKE
Suffix:
Gender:F
Credentials:FNP-BC, PSY D
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:
Other - Last Name:RUSH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC, PSY D
Mailing Address - Street 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:847-390-4757
Practice Address - Street 1:1441 BRANDING AVE STE 310
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5624
Practice Address - Country:US
Practice Address - Phone:630-829-1038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071004832103T00000X
IN20040839A103T00000X
IL20901005363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
620004459OtherRR MEDICARE
01606295OtherBCBS
620004459OtherRR MEDICARE
4467571Medicare UPIN