MEDICARE: SUSAN KATELLO APRN

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
1	363LA2200X	Adult Health Nurse Practitioner	277.000694	IL

General Provider Information

NPI Number	:	1073863148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN KATELLO APRN

Provider Business Mailing Address
First Line	:	12251 S 80TH AVE
Second Line	:	SUITE 1630
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1256
Country	:	US
Telephone Number	:	708-923-5173
Fax Number	:	708-923-5018

Provider Business Practice Location Address
First Line	:	12251 S. 80TH AVE
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-0930
Country	:	US
Telephone Number	:	708-923-8025
Fax Number	:	708-923-8038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2012
Last Update Date	:	06/02/2020

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