Individual
FAYETTE POWERS WERNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1S450 SUMMIT AVE STE 165, OAKBROOK TERRACE, IL 60181-3952
(630) 320-6871
Mailing address
1S450 SUMMIT AVE STE 165, OAKBROOK TERRACE, IL 60181-3952
(630) 320-6871
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110002200
VA
363A00000X
Physician Assistant
Primary
085004332
IL
363AM0700X
Medical Physician Assistant
PA030489
DC
Other
Enumeration date
04/25/2006
Last updated
02/02/2022
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