Healthcare Provider Details

I. General information

NPI: 1861409393
Provider Name (Legal Business Name): MAUREEN E MORAN PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAUREEN E HICKEY

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 WARRENVILLE RD STE 280
DOWNERS GROVE IL
60515
US

IV. Provider business mailing address

2650 WARRENVILLE RD STE 280
DOWNERS GROVE IL
60515
US

V. Phone/Fax

Practice location:
  • Phone: 630-324-7911
  • Fax: 630-324-7942
Mailing address:
  • Phone: 630-324-7911
  • Fax: 630-324-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085000424
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: