Individual
LISA KATHERINE FASONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1502 PARKVIEW AVE, ROCKFORD, IL 61107-1821
(815) 381-7250
(815) 381-7251
Mailing address
1502 PARKVIEW AVE, ROCKFORD, IL 61107-1821
(815) 381-7250
(815) 381-7251
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007338
IL
Other
Enumeration date
10/29/2019
Last updated
10/29/2019
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