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NPI Code Detail

MEDICARE: LISA KATHERINE FASONE PA-C

MEDICARE: LISA KATHERINE FASONE PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant085007338IL

General Provider Information

NPI Number : 1932743432
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA KATHERINE FASONE PA-C
Provider Business Mailing Address
First Line : 1502 PARKVIEW AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-1821
Country : US
Telephone Number : 815-381-7250
Fax Number : 815-381-7251
Provider Business Practice Location Address
First Line : 1502 PARKVIEW AVE
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-1821
Country : US
Telephone Number : 815-381-7250
Fax Number : 815-381-7251
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2019
Last Update Date : 10/29/2019

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Directions to “ LISA KATHERINE FASONE PA-C” Practice Location

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