MEDICARE: SUSAN L PELUCHIWSKI CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	041323445	IL

General Provider Information

NPI Number	:	1437158086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN L PELUCHIWSKI CRNA

Provider Business Mailing Address
First Line	:	2413 W ALGONQUIN RD # 608
Second Line	:
City	:	ALGONQUIN
State	:	IL
Zip	:	60102-9402
Country	:	US
Telephone Number	:	224-333-0033
Fax Number	:

Provider Business Practice Location Address
First Line	:	1555 BARRINGTON RD
Second Line	:
City	:	HOFFMAN ESTATES
State	:	IL
Zip	:	60169-1019
Country	:	US
Telephone Number	:	847-490-2923
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2005
Last Update Date	:	06/11/2008

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