Provider Demographics
NPI:1417088071
Name:MENOCCI, ERICA L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERICA
Middle Name:L
Last Name:MENOCCI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 HAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-2020
Mailing Address - Country:US
Mailing Address - Phone:630-533-3056
Mailing Address - Fax:
Practice Address - Street 1:1914 HAMPTON DR
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-2020
Practice Address - Country:US
Practice Address - Phone:630-533-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002589363A00000X
PAMA053428363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA142201RQJMedicare PIN