Mettille, Susan M
Mettille, Susan M is an individual health care provider with primary practice located at 2805 N Knoxville Ave , Peoria IL 61604-2869. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Mettille, Susan M can be contacted via phone (309) 624-9400.Contact Information
Primary practice address
2805 N Knoxville Ave
Peoria IL 61604-2869
Phone: (309) 624-9400
Fax: (309) 624-2280
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | Illinois |
Profile Details
NPI number | 1790727410 |
---|---|
LBN Legal business name | Mettille, Susan M |
Credentials | Physician's Assistant Certified (PA-C) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Jun 11th, 2006 |
Last updated | Feb 19th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1790727410 | NPPES |
Illinois | Other | 809840 | MEDICARE - GROUP # |
Illinois | Other | 208846 | MEDICARE - GROUP # |
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