Healthcare Provider Details

I. General information

NPI: 1073490884
Provider Name (Legal Business Name): NISA ASGHAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 FEATHERSTONE RD # 200
ROCKFORD IL
61107-6303
US

IV. Provider business mailing address

698 FEATHERSTONE RD # 200
ROCKFORD IL
61107-6303
US

V. Phone/Fax

Practice location:
  • Phone: 815-398-3277
  • Fax:
Mailing address:
  • Phone: 815-398-3277
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085011656
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: