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Contact Information

SAMANTHA JERUSAL
2418 W DIVISION ST
CHICAGO, IL60622-2940
 Phone: 312-666-3494
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pediatrics

363LP0200X 50 Nurse Practitioner
 

Pediatrics

163WP0200X
Indicates primary specialty

NPI Profile & details for SAMANTHA JERUSAL · (Female)

NPI # 1013610971
Status Active
Credentials
Entity Individual
Enumeration date 03/22/2023
Last updated 09/05/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • IL License # 209.028195
  • OH License # 501051
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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