SUSAN J MACK (NPI# 1396955316) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396955316 |
| Entity Type | Individual |
| Full Name | SUSAN J MACK |
| Credential | RN, FNP |
| Practice Address |
929 Stacy Burk Drive Flora IL 62839 |
| Mailing Address |
608 N Main St Flora IL 62839-1406 |
| Practice Telephone | 6186622191 |
| Mailing Telephone | 6186624246 |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2016-05-06 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209007907 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
070430 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 420123507 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790082436 | Susan L Mack | Homeopath | 6484 Ford Rd, Flowery Branch, GA 30542-2636 | 2011-02-15 |
| 1669616793 | Susan Mack | Speech-Language Pathologist | 15 Dovehill Cir, Penfield, NY 14526-1981 | 2009-04-20 |
| 1003808270 | Susan Ann Mack | Nurse Practitioner | 514 Teela Ln, Des Plaines, IL 60016-1230 | 2005-08-16 |
| 1235492356 | Susan Melissa Mack | Massage Therapist | 18407 Pacific Ave S, Spanaway, WA 98387-8374 | 2012-06-22 |
| 1356596217 | Susan Mack | Occupational Therapist | 4016 Raintree Rd, Suite 240, Chesapeake, VA 23321-3700 | 2008-11-19 |
| 1093986747 | Susan Mack | Social Worker | 107 S 5th St, Richmond, VA 23219-3825 | 2008-03-20 |
| 1750490538 | Susan M Mack | Physical Therapist | 1830 112th St E, Ste D, Tacoma, WA 98445-3747 | 2006-08-29 |
| Street Address |
929 STACY BURK DRIVE |
| City | FLORA |
| State | IL |
| Zip Code | 62839 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730165788 | Cheryl Jane White | Nurse Practitioner | 929 Stacy Burk Drive, Flora, IL 62839-3241 | 2005-12-21 |
| 1548510357 | Ponciano Pormentira Jr. | Physical Therapist | 929 Stacy Burk Drive, Flora, IL 62839 | 2012-09-19 |
| 1447450085 | Michael Paul Klingler | Pediatrics | 929 Stacy Burk Drive, Flora, IL 62839-3241 | 2007-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467887455 | Gayla Kay Dunaway | Occupational Therapist | 232 Givens Dr, Flora, IL 62839 | 2013-09-09 |
| 1952652349 | Health Care Management Corporation | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 408 E 4th St, Rosewood Estates, Flora, IL 62839 | 2012-09-25 |
| 1437445947 | Gaurav Nigam | Family Medicine | 911 Stacy Burk Drive, Flora, IL 62839 | 2011-06-22 |
| 1831413947 | Philip K.c. Chung | Obstetrics & Gynecology | 116 East 4th, Floria, IL 62839 | 2010-03-18 |
| 1669672465 | Heritage Woods LLC | Assisted Living Facility | 1003 West 4th Street, Flora, IL 62839 | 2007-07-19 |
| 1043365968 | Martin Dental Associates PC | Dentist | 501 North Main Street, Flora, IL 62839 | 2007-01-23 |
| 1518047356 | Linda L Robards | Registered Nurse | Clay Medical Center, 201 E N Avenue, Flora, IL 62839 | 2006-10-16 |
| 1144312000 | Valerie Jill Henderson | Registered Nurse | 201 E N Avenue, Clay Medical Center, Flora, IL 62839 | 2006-09-29 |
| 1164523221 | Kimberly Ann Greenwalt | Licensed Practical Nurse | 201 E N Ave, Clay Medical Center, Flora, IL 62839 | 2006-09-25 |
| 1558879676 | Melissa Kay Laslie | Registered Nurse | 911 Stacy Burk Drive, Flora, IL 62839 | 2018-01-11 |
| Find all providers in zip 62839 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013496819 | Catherine Nicole Deters | Nurse Practitioner | 911 Stacey Burk Dr, Flora, IL 62839-3241 | 2018-08-13 |
| 1316314933 | Marlissa Boyles | Nurse Practitioner | 201 E North Ave, Flora, IL 62839-2030 | 2015-08-31 |
| 1316338890 | Angela Casolari | Nurse Practitioner | 929 Stacey Burk Dr, Flora, IL 62839-3241 | 2015-02-05 |
| 1609031772 | Michele K. Hartke | Nurse Practitioner | 929 Stacey Burk Dr, Flora, IL 62839-3241 | 2008-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538760277 | Jennifer Michelle Kennedy | Nurse Practitioner | 3006 Lakeview Dr, Metropolis, IL 62960-3119 | 2020-11-07 |
| 1881295541 | Britney Julia Durst | Nurse Practitioner | 5905 N Prospect Rd, Peoria, IL 61614-4311 | 2020-11-07 |
| 1952902884 | Julia Ann Gottschalk | Nurse Practitioner | 1979 Mcdowell Rd, Unit 103, Naperville, IL 60563 | 2020-11-06 |
| 1932700911 | Laura Ivette Portillo | Nurse Practitioner | 2727 N Marmora Ave, Chicago, IL 60639-1219 | 2020-11-05 |
| 1265033385 | Carolle M Derradji | Nurse Practitioner | 3256 W Potomac Ave, Chicago, IL 60651-2411 | 2020-11-04 |
| 1104427293 | Katie Michelle O'halloran | Nurse Practitioner | 5841 S Maryland Ave # E500, Chicago, IL 60637-1443 | 2020-11-04 |
| 1598365140 | Caitlyn Windsor | Nurse Practitioner | 24525 Grange Rd, Geneseo, IL 61254-8429 | 2020-10-31 |
| 1578163515 | Deanna Bassette | Nurse Practitioner | 243 E 31st St Apt 401, Chicago, IL 60616-5212 | 2020-10-29 |
| 1891395745 | Vrunda Shah Patel | Nurse Practitioner | 933 W Van Buren St Apt 502, Chicago, IL 60607-3583 | 2020-10-29 |
| 1346840337 | Catherine Suh | Nurse Practitioner | 1380 Marcy Ln, Wheeling, IL 60090-4422 | 2020-10-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.