Individual
MEGHANN REID VIZINTOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1763 FREEDOM DR STE 117, NAPERVILLE, IL 60563
(630) 687-9595
Mailing address
1763 FREEDOM DR STE 117, NAPERVILLE, IL 60563-3553
(630) 687-9595
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
85007364
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85007364
ILLINOIS PA LICENSE
IL
Enumeration date
10/04/2019
Last updated
12/06/2019
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