Individual
JESSICA WENIGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
391 S BOLINGBROOK DR, BOLINGBROOK, IL 60440-3411
(630) 226-1006
(630) 226-9003
Mailing address
10100 FOREST HILLS RD, MACHESNEY PARK, IL 61115-8234
(815) 713-2742
(815) 282-8597
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003264
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085003264
ILLINOIS PA LICENSE
IL
Enumeration date
10/08/2008
Last updated
10/08/2008
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