Provider Demographics
NPI:1356462030
Name:FLUCKER, VENITA ROCHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:VENITA
Middle Name:ROCHELLE
Last Name:FLUCKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VENITA
Other - Middle Name:R
Other - Last Name:FLUCKER PA-C
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:8127 S LOOMIS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3859
Mailing Address - Country:US
Mailing Address - Phone:773-994-9203
Mailing Address - Fax:312-864-5921
Practice Address - Street 1:8127 S LOOMIS BLVD
Practice Address - Street 2:1900 W.POLK SUITE 500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3859
Practice Address - Country:US
Practice Address - Phone:312-864-5900
Practice Address - Fax:312-864-9579
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85001970282N00000X
IL085-001970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No282N00000XHospitalsGeneral Acute Care Hospital