Healthcare Provider Details

I. General information

NPI: 1598371189
Provider Name (Legal Business Name): STEPHANIE MUNOZ NHIM RN, BSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 12/14/2024
Certification Date: 12/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 CORNERSTONE CT W STE 300
SAN DIEGO CA
92121-3772
US

IV. Provider business mailing address

4440 CAPSTAN DR
HOFFMAN ESTATES IL
60192-1006
US

V. Phone/Fax

Practice location:
  • Phone: 858-550-7107
  • Fax:
Mailing address:
  • Phone: 224-238-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209021850
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041430477
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: