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General NPI Number Information
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NPI Number | 1255886131
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Entity Type | Individual
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Provider Name | IRINA TIMOSHEVSKAYA PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/19/2016
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Last Update Date | 09/21/2016
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Provider Practice Location Address
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Address Line | 350 S GREENLEAF ST SUITE 405
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City | GURNEE
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State | IL
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Zip | 60031-5709
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Country | US
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Telephone | 847-336-3335
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Fax | 847-336-3249
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Provider Business Mailing Address
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Address Line | 900 RAND RD SUITE 300
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City | DES PLAINES
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State | IL
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Zip | 60016-2359
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Country | US
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Telephone | 847-324-3976
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Fax | 847-929-1154
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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 | 085005919
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License Number State | IL
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