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NPI Code Detail

MEDICARE: PHYLLIS SASU

MEDICARE:   PHYLLIS  SASU
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WM0705XMedical-Surgical Registered Nurse041.400848IL
2163WP0807XChild & Adolescent Psychiatric/Mental Health Registered Nurse041.400848IL
3163WH0200XHome Health Registered Nurse041.400848IL

General Provider Information

NPI Number : 1003326430
Entity Type Code : Individual
Provider Name (Legal Business Name) : PHYLLIS SASU
Provider Business Mailing Address
First Line : 525 E 46TH PL
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4205
Country : US
Telephone Number : 773-507-8609
Fax Number :
Provider Business Practice Location Address
First Line : 525 E 46TH PL
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4205
Country : US
Telephone Number : 773-507-8609
Fax Number : 773-507-8609
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/12/2017
Last Update Date : 10/12/2017

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Directions to “ PHYLLIS SASU ” Practice Location

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