Individual
JESSICA E MUCCIANTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA C
Contact information
Practice address
1253 N ALPINE RD, ROCKFORD, IL 61107
(779) 696-9201
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
(779) 696-7342
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085 003424
IL
Other
Enumeration date
02/10/2009
Last updated
02/19/2021
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