Provider Demographics
NPI:1497538185
Name:PRUCHA, GIANNA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:GIANNA
Middle Name:MARIE
Last Name:PRUCHA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:963 N 129TH INFANTRY DR
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-3104
Mailing Address - Country:US
Mailing Address - Phone:877-632-6637
Mailing Address - Fax:708-409-5179
Practice Address - Street 1:963 N 129TH INFANTRY DR
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-3104
Practice Address - Country:US
Practice Address - Phone:877-632-6637
Practice Address - Fax:708-409-5179
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085010068363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant