Provider Demographics
NPI:1144570284
Name:PURCELL, MICHELLE (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:PURCELL
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:PEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:120 SPALDING DR STE 207
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6520
Mailing Address - Country:US
Mailing Address - Phone:630-646-6020
Mailing Address - Fax:630-646-6064
Practice Address - Street 1:120 SPALDING DR STE 207
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540
Practice Address - Country:US
Practice Address - Phone:630-646-6020
Practice Address - Fax:630-646-6064
Is Sole Proprietor?:No
Enumeration Date:2012-09-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085004507363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL085004507OtherIL PA LICENSE
ILMP2750304OtherDEA