Individual
ELLISSA A SCHWARTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
6830 VILLAGREEN VW, ROCKFORD, IL 61107-5639
(815) 282-1339
(815) 282-1298
Mailing address
6830 VILLAGREEN VIEW, OSF MEDICAL GROUP-SPRINGCREEK, ROCKFORD, IL 61107-5639
(815) 282-1339
(815) 282-1298
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002771
IL
363A00000X
Physician Assistant
2370-023
WI
363A00000X
Physician Assistant
MA #052890
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
553180
MEDICARE GROUP PTAN
IL
01
—
834340
MEDICARE GROUP PTAN
IL
01
—
846930
MEDICARE GROUP PTAN
IL
Enumeration date
05/07/2007
Last updated
11/24/2009
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