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NPI Code Detail

MEDICARE: DR. SUSAN K. MANGANO APN-CNP

MEDICARE: DR. SUSAN K. MANGANO APN-CNP
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner209015356IL
2363L00000XNurse Practitioner209015356IL

General Provider Information

NPI Number : 1598200701
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUSAN K. MANGANO APN-CNP
Provider Business Mailing Address
First Line : 2650 RIDGE AVE STE 1223
Second Line :
City : EVANSTON
State : IL
Zip : 60201-1700
Country : US
Telephone Number : 847-570-2040
Fax Number : 847-570-5315
Provider Business Practice Location Address
First Line : 1335 N MILL ST STE 100
Second Line :
City : NAPERVILLE
State : IL
Zip : 60563-2047
Country : US
Telephone Number : 630-646-8000
Fax Number : 630-646-6007
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2016
Last Update Date : 03/19/2026

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