Provider Demographics
NPI:1518453117
Name:REISBERG, SUSAN RACHEL (APN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:RACHEL
Last Name:REISBERG
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 LOUISE ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3427
Mailing Address - Country:US
Mailing Address - Phone:847-679-5946
Mailing Address - Fax:847-673-8606
Practice Address - Street 1:5127 OAKTON ST
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-3633
Practice Address - Country:US
Practice Address - Phone:847-933-8252
Practice Address - Fax:847-673-8606
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily