Petria Laura Idita, PA-C

NPI #1417650938 in Glenview, Illinois

Provider Information

NPI Number: 1417650938
Entity Type: Individual
Name: Petria Laura Idita, PA-C
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA-C
Enumeration Date: Mar 23, 2023
Last Updated: Mar 31, 2023

Practice Location

Address: 2300 CHESTNUT AVE UNIT 100
City: Glenview
State: Illinois
ZIP Code: 60026-1612
Phone: (847) 786-5200

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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