Susan Marie Boose, LPN
Individual provider Active NPI Licensed Practical Nurse · Forest Park, IL
NPI 1336713221 · NPPES record last updated May 17, 2021
Key facts
- NPI
- 1336713221
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 043.051922 (IL)
- Practice address
- 1315 Marengo Ave
Forest Park, IL 60130-2434 - Phone
- (708) 366-7498
- NPI assigned
- May 17, 2021
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 043.051922 | IL | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 043.051922 | IL | Yes |
Addresses
Primary practice location
1315 Marengo Ave
Forest Park, IL 60130-2434
Mailing address
1315 Marengo Ave
Forest Park, IL 60130-2434
Other providers in Forest Park, IL
- Iwona Bialon Wnek
- Lindsay Erin Bjork
- Blue Cab Co
- Daniel P Boffa
- Allison Bogs
- Grace Bougher
- Dawn T Bounds
- Brianna Boyd
- Anna Bretschneider
- Brooke Management Corp
All providers in Forest Park, IL · Licensed Practical Nurse in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.