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General NPI Number Information
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NPI Number | 1003029224
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Entity Type | Individual
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Provider Name | ELLISSA A SCHWARTZ PHYSICIAN ASSISTANT
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 11/24/2009
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Provider Practice Location Address
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Address Line | 6830 VILLAGREEN VW
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City | ROCKFORD
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State | IL
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Zip | 61107-5639
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Country | US
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Telephone | 815-282-1339
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Fax | 815-282-1298
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Provider Business Mailing Address
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Address Line | 6830 VILLAGREEN VIEW OSF MEDICAL GROUP-SPRINGCREEK
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City | ROCKFORD
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State | IL
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Zip | 61107-5639
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Country | US
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Telephone | 815-282-1339
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Fax | 815-282-1298
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 085-002771
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | MA #052890
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 2370-023
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License Number State | WI
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