MEDICARE: CRYSTAL J STAMPS CNM, PMHNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	176B00000X	Midwife		IL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	209.030818	IL

General Provider Information

NPI Number	:	1528579372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL J STAMPS CNM, PMHNP

Provider Business Mailing Address
First Line	:	848 GARDNER RD
Second Line	:
City	:	FLOSSMOOR
State	:	IL
Zip	:	60422-1358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 S WOOD ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1202
Country	:	US
Telephone Number	:	773-355-2970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2017
Last Update Date	:	01/20/2026

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