Individual
PETRIA LAURA IDITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2300 CHESTNUT AVE UNIT 100, GLENVIEW, IL 60026-1612
(847) 786-5200
Mailing address
441 E ERIE ST APT 4404, CHICAGO, IL 60611-4434
(313) 850-0229
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085009596
IL
Other
Enumeration date
03/23/2023
Last updated
03/31/2023
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