Provider Demographics
NPI:1952353070
Name:GALANES, SUSAN (MS)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GALANES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-1295
Mailing Address - Country:US
Mailing Address - Phone:630-690-4993
Mailing Address - Fax:630-690-2293
Practice Address - Street 1:25 N WINFIELD RD
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-1295
Practice Address - Country:US
Practice Address - Phone:630-690-4993
Practice Address - Fax:630-690-2293
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209004194363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
ILF400186615OtherMEDICARE PTAN (INDIVIDUAL)
IL$$$$$$$$$001OtherMEDICAID
IL206147OtherMEDICARE PTAN (GROUP)
ILP00079144Medicare PIN
ILF400186615OtherMEDICARE PTAN (INDIVIDUAL)
IL$$$$$$$$$001OtherMEDICAID