Healthcare Provider Details

I. General information

NPI: 1285509075
Provider Name (Legal Business Name): SUSANNA FAITH FRUSTI APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 MAXINE DR
MORTON IL
61550-2498
US

IV. Provider business mailing address

1314 KENNETH DR
BLOOMINGTON IL
61704-2588
US

V. Phone/Fax

Practice location:
  • Phone: 309-263-2424
  • Fax:
Mailing address:
  • Phone: 224-208-5889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209033472
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209.033472
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: