Healthcare Provider Details

I. General information

NPI: 1023429065
Provider Name (Legal Business Name): IZABELA AGNIESZKA HOLANDAY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2014
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 NORTH WINFIELD ROAD
WINFIELD IL
60190-1295
US

IV. Provider business mailing address

25 N WINFIELD RD.
WINFIELD IL
60190-1295
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4257
  • Fax: 630-933-4520
Mailing address:
  • Phone: 630-933-4257
  • Fax: 630-933-4520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005050
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: