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General NPI Number Information
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NPI Number | 1356828230
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Entity Type | Individual
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Provider Name | JAMIE HITRO PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 05/07/2021
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Provider Practice Location Address
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Address Line | 121 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60610
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Country | US
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Telephone | 312-643-5606
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 E HIGGINS RD STE 600
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City | DES PLAINES
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State | IL
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Zip | 60018-5621
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Country | US
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Telephone | 847-653-0130
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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 | 085.006622
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License Number State | IL
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