Healthcare Provider Details

I. General information

NPI: 1659108553
Provider Name (Legal Business Name): STEPHANIE MOY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 S MARYLAND AVE
CHICAGO IL
60637-1426
US

IV. Provider business mailing address

5700 S MARYLAND AVE
CHICAGO IL
60637-1426
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-9123
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209030415
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95031682
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95120973
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number041436857
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: