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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790727410 NPPES
Illinois Other 809840 MEDICARE - GROUP #
Illinois Other 208846 MEDICARE - GROUP #

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