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NPI Code Detail

MEDICARE: BRITTANY DIEC MMS, PA-C

MEDICARE: BRITTANY DIEC MMS, PA-C
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
1363A00000XPhysician Assistant085010125IL

General Provider Information

NPI Number : 1043931488
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRITTANY DIEC MMS, PA-C
Provider Business Mailing Address
First Line : 1859 W CHICAGO AVE APT 3F
Second Line :
City : CHICAGO
State : IL
Zip : 60622-5552
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1859 W CHICAGO AVE APT 3F
Second Line :
City : CHICAGO
State : IL
Zip : 60622-5552
Country : US
Telephone Number : 316-880-1298
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/05/2022
Last Update Date : 04/18/2024

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Directions to “ BRITTANY DIEC MMS, PA-C” Practice Location

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