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General NPI Number Information
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NPI Number | 1164338091
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Entity Type | Individual
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Provider Name | SUSAN FULARA RNC
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Gender | Female
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Dates
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Enumeration Date | 08/20/2026
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Last Update Date | 08/20/2026
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Provider Practice Location Address
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Address Line | 900 N KINGSBURY ST STE 130N
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City | CHICAGO
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State | IL
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Zip | 60610-7457
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Country | US
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Telephone | 312-775-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 5913 N MERRIMAC AVE
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City | CHICAGO
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State | IL
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Zip | 60646-5326
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Country | US
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Telephone | 773-308-5173
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.212029
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License Number State | IL
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