Healthcare Provider Details

I. General information

NPI: 1144041112
Provider Name (Legal Business Name): EMILY MARIE BORSELLINO PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 N WINFIELD RD STE 505
WINFIELD IL
60190-1379
US

IV. Provider business mailing address

25 N WINFIELD RD STE 505
WINFIELD IL
60190-1379
US

V. Phone/Fax

Practice location:
  • Phone: 630-938-6161
  • Fax:
Mailing address:
  • Phone: 630-938-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: