Individual
MS. LIDIA S POMAVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3253 S HARLEM AVE, SUITE 1A, BERWYN, IL 60402-3073
(262) 898-4400
(708) 788-6884
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(866) 630-9882
(920) 682-5810
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-004255
IL
Other
Enumeration date
03/08/2012
Last updated
02/23/2021
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