Provider Demographics
NPI:1174832646
Name:DUFFY, ANNA MORRISA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:MORRISA
Last Name:DUFFY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:MORRISA
Other - Last Name:MACK (MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:927 W SUNNYSIDE AVE
Mailing Address - Street 2:#1N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6062
Mailing Address - Country:US
Mailing Address - Phone:630-975-0122
Mailing Address - Fax:
Practice Address - Street 1:1333 WEST BELMONT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657
Practice Address - Country:US
Practice Address - Phone:312-694-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-01
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-004695363A00000X
AZ4721363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical