Individual
EMILY PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-5580
Mailing address
8509 ARDENNES DR, FISHERS, IN 46038-4402
(317) 366-3662
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085007408
IL
363AS0400X
Surgical Physician Assistant
C0006904
MD
Other
Enumeration date
08/13/2018
Last updated
05/13/2022
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