Provider Demographics
NPI:1992800270
Name:CIRRINCIONE, MEREDITH MYKEL (MS, PA-C)
Entity type:Individual
Prefix:MRS
First Name:MEREDITH
Middle Name:MYKEL
Last Name:CIRRINCIONE
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:MISS
Other - First Name:MEREDITH
Other - Middle Name:MYKEL
Other - Last Name:LAGESSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, PA-C
Mailing Address - Street 1:744 N GARY AVE UNIT 113
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188-4903
Mailing Address - Country:US
Mailing Address - Phone:630-681-8840
Mailing Address - Fax:
Practice Address - Street 1:1051 ESSINGTON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-2801
Practice Address - Country:US
Practice Address - Phone:815-744-0808
Practice Address - Fax:815-744-8345
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILQ02134Medicare UPIN