Healthcare Provider Details

I. General information

NPI: 1326345141
Provider Name (Legal Business Name): SUSAN GRACE DRABING FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2011
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E HIGHWAY 50
O FALLON IL
62269-2704
US

IV. Provider business mailing address

124 WINDSOR DR
TROY IL
62294-2847
US

V. Phone/Fax

Practice location:
  • Phone: 618-624-3368
  • Fax: 618-624-3387
Mailing address:
  • Phone: 618-667-6599
  • Fax: 618-667-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008650041254438
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: