Provider Demographics
NPI:1699005678
Name:VEZZETTI, ANGELA MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:VEZZETTI
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:920 WEST ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2763
Mailing Address - Country:US
Mailing Address - Phone:815-223-4400
Mailing Address - Fax:815-223-4401
Practice Address - Street 1:920 WEST ST
Practice Address - Street 2:SUITE 312
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2763
Practice Address - Country:US
Practice Address - Phone:815-223-4400
Practice Address - Fax:815-223-4401
Is Sole Proprietor?:No
Enumeration Date:2010-01-13
Last Update Date:2017-04-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085003586363A00000X
MO2010000470363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant