Healthcare Provider Details

I. General information

NPI: 1346676509
Provider Name (Legal Business Name): LISA STEFFENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2013
Last Update Date: 12/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CURTIS RD ADULT MEDICINE
CHAMPAIGN IL
61822-9678
US

IV. Provider business mailing address

611 W PARK ST BWPC
URBANA IL
61801-2500
US

V. Phone/Fax

Practice location:
  • Phone: 217-383-6207
  • Fax: 217-383-6380
Mailing address:
  • Phone: 217-383-6792
  • Fax: 217-383-4752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209010566
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: