Provider Demographics
NPI:1609950807
Name:PAJEAU, NICHELLE J (PA,)
Entity Type:Individual
Prefix:MISS
First Name:NICHELLE
Middle Name:J
Last Name:PAJEAU
Suffix:
Gender:F
Credentials:PA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6131 DEMPSTER ST
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053-2953
Mailing Address - Country:US
Mailing Address - Phone:847-967-5010
Mailing Address - Fax:847-967-5147
Practice Address - Street 1:6131 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053-2953
Practice Address - Country:US
Practice Address - Phone:847-967-5010
Practice Address - Fax:847-967-5147
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85002728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL85002728OtherPROFESSIONAL LICENCE