Healthcare Provider Details

I. General information

NPI: 1720419336
Provider Name (Legal Business Name): BRITTANY FARIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N VINE ST
ARTHUR IL
61911-1130
US

IV. Provider business mailing address

1200 NORTH EAST STREET
OLNEY IL
62450
US

V. Phone/Fax

Practice location:
  • Phone: 217-543-2446
  • Fax: 217-543-2548
Mailing address:
  • Phone: 618-395-5222
  • Fax: 618-395-8552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085004958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: