Healthcare Provider Details

I. General information

NPI: 1306140538
Provider Name (Legal Business Name): SUSAN OSAYI-ADAMS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2011
Last Update Date: 03/09/2024
Certification Date: 03/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1672 S 9TH ST
MILWAUKEE WI
53204-3426
US

IV. Provider business mailing address

1862 E BELVIDERE RD STE 201
GRAYSLAKE IL
60030-2289
US

V. Phone/Fax

Practice location:
  • Phone: 847-977-0001
  • Fax:
Mailing address:
  • Phone: 847-977-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.029377
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14961-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: