Individual
BREE ANN DALLINGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
680 N LAKE SHORE DR, CHICAGO, IL 60611-4546
(312) 695-6868
Mailing address
1018 E LOWDEN AVE, WHEATON, IL 60189-6622
(207) 841-9259
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085.006864
IL
363A00000X
Physician Assistant
PA4250
MA
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110022061B
GROUP MEDICAID NUMBER
MA
Enumeration date
06/24/2011
Last updated
04/22/2019
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