Provider Demographics
NPI:1215074869
Name:RAHMAN, GRISELDA HERNANDEZ (PA-C)
Entity type:Individual
Prefix:MRS
First Name:GRISELDA
Middle Name:HERNANDEZ
Last Name:RAHMAN
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 1:6065 S 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:IL
Mailing Address - Zip Code:60501-1533
Mailing Address - Country:US
Mailing Address - Phone:708-496-0351
Mailing Address - Fax:
Practice Address - Street 1:1111 SUPERIOR ST
Practice Address - Street 2:SUITE 302
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-4138
Practice Address - Country:US
Practice Address - Phone:708-344-0808
Practice Address - Fax:708-344-5055
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85002784363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant