Healthcare Provider Details

I. General information

NPI: 1831199587
Provider Name (Legal Business Name): DAWN CARROLL ROMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN CARROLL GERCHAR PA-C

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 ESSINGTON RD SUITE 280
JOLIET IL
60435-2801
US

IV. Provider business mailing address

820 SPRINGER DR
LOMBARD IL
60148-6413
US

V. Phone/Fax

Practice location:
  • Phone: 815-744-8554
  • Fax: 815-744-3969
Mailing address:
  • Phone: 815-744-8554
  • Fax: 630-495-1770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number10000242A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number085000381
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: