Provider Demographics
NPI:1669563805
Name:MAZENIS, RHIANNON (PA-C)
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:
Last Name:MAZENIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RHIANNON
Other - Middle Name:
Other - Last Name:SATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1365 WILEY RD
Mailing Address - Street 2:STE 153
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-4357
Mailing Address - Country:US
Mailing Address - Phone:847-519-4701
Mailing Address - Fax:847-519-4707
Practice Address - Street 1:5320 159TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-4705
Practice Address - Country:US
Practice Address - Phone:708-798-8112
Practice Address - Fax:708-535-6396
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL385001545363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant