| Doctor Name: | MS. SUSAN JEAN FAIRLEY-HOLBACH |
| NPI Number: | 1114162864 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NURSE PRACTITIONER |
| License Number: | 209.007359 |
| Business Practice Address: | 2520 Elisha Ave Zion, IL - 600992676 |
| Business Phone Number: | 8478724888 |
| Business Fax Number: | 8478725716 |
| Mailing Address: | 2520 Elisha Ave, ZION |
| State: | IL |
| Postal Code: | 600992676 |
| Phone Number: | 8478724448 |
| Fax Number: | 8478725716 |
| NPI Enumeration Date: | 12/10/2008 |
| NPI Last Update Date: | 05/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 209.007359 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |