Provider Demographics
NPI:1255098992
Name:SIGNORELLA, PAMELA A (L AC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:A
Last Name:SIGNORELLA
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WILLOWCREST DR
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2660
Mailing Address - Country:US
Mailing Address - Phone:630-479-0623
Mailing Address - Fax:
Practice Address - Street 1:28 WILLOWCREST DR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2660
Practice Address - Country:US
Practice Address - Phone:630-479-0623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL198-000544171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist