Provider Demographics
NPI:1720481682
Name:PANICKER, RINCY (PA-C)
Entity Type:Individual
Prefix:
First Name:RINCY
Middle Name:
Last Name:PANICKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 GOLFVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60139-3675
Mailing Address - Country:US
Mailing Address - Phone:224-381-1984
Mailing Address - Fax:
Practice Address - Street 1:139 GOLFVIEW DR
Practice Address - Street 2:
Practice Address - City:GLENDALE HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60139-3675
Practice Address - Country:US
Practice Address - Phone:224-381-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA14525363A00000X
LA330590363A00000X
IL085.005269363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant