Basic Information
| Provider Information | |||||||||
| NPI: | 1720419336 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARIS | ||||||||
| FirstName: | BRITTANY | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 NORTH EAST STREET | ||||||||
| Address2: | |||||||||
| City: | OLNEY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 62450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6183955222 | ||||||||
| FaxNumber: | 6183958552 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 N VINE ST | ||||||||
| Address2: | |||||||||
| City: | ARTHUR | ||||||||
| State: | IL | ||||||||
| PostalCode: | 619111130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175432446 | ||||||||
| FaxNumber: | 2175432548 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2013 | ||||||||
| LastUpdateDate: | 06/14/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 085004958 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.