Healthcare Provider Details

I. General information

NPI: 1619018991
Provider Name (Legal Business Name): ERIN STILLWELL PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 OGDEN AVE SUITE 140
AURORA IL
60504-5894
US

IV. Provider business mailing address

2020 OGDEN SUITE 140
AURORA IL
60504
US

V. Phone/Fax

Practice location:
  • Phone: 630-851-1144
  • Fax: 630-851-8837
Mailing address:
  • Phone: 630-851-1144
  • Fax: 630-851-8837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: