Provider Demographics
NPI:1053935494
Name:BARCARSE, JANET RONQUILLO
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:RONQUILLO
Last Name:BARCARSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 S. SCHMIDT ROAD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-1737
Mailing Address - Country:US
Mailing Address - Phone:630-312-4562
Mailing Address - Fax:630-312-6651
Practice Address - Street 1:420 S. SCHMIDT ROAD
Practice Address - Street 2:SUITE 110
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440-1737
Practice Address - Country:US
Practice Address - Phone:630-312-4562
Practice Address - Fax:630-312-6651
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X, 363AM0700X
IL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program