Healthcare Provider Details

I. General information

NPI: 1932972056
Provider Name (Legal Business Name): BONNIE STEVENS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 06/17/2024
Certification Date: 11/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 MCCLINTOCK DR STE 360
BURR RIDGE IL
60527-0875
US

IV. Provider business mailing address

745 MCCLINTOCK DR STE 360
BURR RIDGE IL
60527-0875
US

V. Phone/Fax

Practice location:
  • Phone: 630-832-1775
  • Fax:
Mailing address:
  • Phone: 630-832-1775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209028578
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.028578
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: