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General NPI Number Information
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NPI Number | 1316486459
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Entity Type | Individual
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Provider Name | NICOLE M TRITTSCHUH PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/22/2017
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 801 S MILWAUKEE AVE
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City | LIBERTYVILLE
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State | IL
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Zip | 60048-3204
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Country | US
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Telephone | 847-362-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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Fax |
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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 | 085.006175
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085-006175
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License Number State | IL
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