Suzette Mennie
Individual provider Active NPI Attendant Care Provider · Mark, IL
NPI 1538716634 · NPPES record last updated Aug 22, 2019
Key facts
- NPI
- 1538716634
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Attendant Care Provider 3747A0650X
- Practice address
- 301 North Milwaukee St.
Mark, IL 61340 - Phone
- (815) 339-2609
- NPI assigned
- Aug 22, 2019
- 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Attendant Care Provider | 3747A0650X | Yes |
Addresses
Primary practice location
301 North Milwaukee St.
Mark, IL 61340
Mailing address
301 North Milwaukee St. P.O. Box 22
Mark, IL 61340
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2019. 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.