Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MAKENZIE DISERIO
Active Sole ProprietorMAKENZIE DISERIO is a Physician Assistant healthcare provider located in DEKALB, Illinois. NPI 1679146302 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · DEKALB, IL
Registration Details
- NPI Number
- 1679146302
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jul 20, 2021 (5.0908641840446 yrs)
- Last Updated
- Oct 10, 2025
- License
-
085.009196 (IL)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1212 S 2ND STDEKALB, IL, 601154435Browse IL providers · Browse ZIP 60115
- Phone
- 8722313162
- Fax
- 7029771496
- Primary Specialty
-
Physician Assistant
363A00000X
Other Physician Assistant Providers in DEKALB, IL
| Name | Credential | NPI |
|---|---|---|
| DEREK J MARATEA | PA-C | 1699919118 |
| MRS. HALEY RANAE GOULSON | PA-C | 1417283938 |
| SADIE DONAGHY | PA-C | 1861140279 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.