Provider Demographics
NPI:1619018991
Name:STILLWELL, ERIN (PAC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 OGDEN
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60504
Mailing Address - Country:US
Mailing Address - Phone:630-851-1144
Mailing Address - Fax:630-851-8837
Practice Address - Street 1:2020 OGDEN AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60504-5894
Practice Address - Country:US
Practice Address - Phone:630-851-1144
Practice Address - Fax:630-851-8837
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical