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Individual

MS. ELIZABETH MARIE DIBELLA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1890 SILVER CROSS BLVD, NEW LENOX, IL 60451-9524
(815) 723-4387
(815) 723-4634
Mailing address
1890 SILVER CROSS BLVD, NEW LENOX, IL 60451-9524
(815) 723-4387
(815) 723-4634

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085004984
IL
363A00000X
Physician Assistant
PA00629
RI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
206147
MEDICARE PTAN (GROUP)
IL
01
F400160420
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
03/07/2012
Last updated
09/11/2014
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