Healthcare Provider Details

I. General information

NPI: 1407948532
Provider Name (Legal Business Name): SUSAN ANN HUBER-BARTLETT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 S CONGRESS ST
RUSHVILLE IL
62681-1409
US

IV. Provider business mailing address

225 S CONGRESS ST
RUSHVILLE IL
62681-1409
US

V. Phone/Fax

Practice location:
  • Phone: 217-322-3529
  • Fax: 217-322-2065
Mailing address:
  • Phone: 217-322-3529
  • Fax: 217-322-2065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085001067
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: