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General NPI Number Information
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NPI Number | 1366125536
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Entity Type | Organization
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Legal Business Name | PENTOM HEALTH SERVICES LLC
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Dates
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Enumeration Date | 08/14/2023
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Last Update Date | 08/14/2023
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Provider Practice Location Address
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Address Line | 516 GRANT ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3024
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Country | US
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Telephone | 630-413-1303
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Fax | 888-311-3015
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Provider Business Mailing Address
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Address Line | 516 GRANT ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3024
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Country | US
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Telephone | 630-413-1303
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MARCIA RADJA
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Credential | FNP
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Telephone | 312-420-5494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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