Provider Demographics
NPI:1851795629
Name:SCHWARZ, MARY DIANE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:DIANE
Last Name:SCHWARZ
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:20025 DIVISION ST..
Mailing Address - Street 2:STATEVILLE NRC
Mailing Address - City:CREST HILL
Mailing Address - State:IL
Mailing Address - Zip Code:60403-0000
Mailing Address - Country:US
Mailing Address - Phone:815-727-3607
Mailing Address - Fax:815-774-3839
Practice Address - Street 1:5618 S THURLOW ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-5128
Practice Address - Country:US
Practice Address - Phone:815-727-3607
Practice Address - Fax:815-774-3839
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085.000580363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical