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Individual

MS. STACIE WHARTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
431 WEST LIBERTY STREET, WAUCONDA, IL 60084
(847) 526-2151
(815) 678-4184
Mailing address
329 REMINGTON BLVD, UNIT 205, BOLINGBROOK, IL 60440-5827
(630) 226-1130
(360) 226-1134

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003268
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
085003268
STATE OF ILLINOIS LICENSE
IL
Enumeration date
10/10/2008
Last updated
12/10/2015
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