Healthcare Provider Details

I. General information

NPI: 1295481471
Provider Name (Legal Business Name): SUZANNE PORER DPT, MSN, MS, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2022
Last Update Date: 10/28/2022
Certification Date: 10/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 CENTER ST
DES PLAINES IL
60016-6404
US

IV. Provider business mailing address

832 CENTER ST
DES PLAINES IL
60016-6404
US

V. Phone/Fax

Practice location:
  • Phone: 312-636-0453
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209.026230
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.497462
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number255477-30
License Number StateWI
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.012257
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: