Petria Laura Idita, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085009596 Issued in IL

Practice address

2300 Chestnut Ave Unit 100
Glenview, IL 60026-1612

Phone

(847) 786-5200

NPI assigned

Mar 23, 2023

Last updated

Mar 31, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680220800000",
    "number": "1417650938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "441 E ERIE ST APT 4404",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606114434",
            "telephone_number": "313-850-0229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 CHESTNUT AVE UNIT 100",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261612",
            "telephone_number": "847-786-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDITA",
        "first_name": "PETRIA",
        "middle_name": "LAURA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-23",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Hutchins, ATC
• Kurt Hutchinson, PT
• Catherine W Hwang, OTR/L
• Reese Hyzer, PHD
• Amy Elizabeth Iaquinta, D.C.
• Melita Nonyerem Igbokwe, MD
• Anna Carmela Gabriel Ignacio, DPT
• Justin Raphael Ignaco, PT, DPT
• Dorota Ignatiuk, PTA
• Sara Ikram

• Physician Assistant in Glenview, IL
• Providers in Glenview, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.