Healthcare Provider Details

I. General information

NPI: 1215645585
Provider Name (Legal Business Name): ELISABETH A VALLONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BLANCHARD CIR STE 104
WHEATON IL
60189-2038
US

IV. Provider business mailing address

7 BLANCHARD CIR STE 104
WHEATON IL
60189-2038
US

V. Phone/Fax

Practice location:
  • Phone: 630-668-0833
  • Fax: 630-668-7685
Mailing address:
  • Phone: 630-668-0833
  • Fax: 630-668-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number085.009050
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.009050
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: