Healthcare Provider Details

I. General information

NPI: 1891324083
Provider Name (Legal Business Name): ROBERT STINES FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S MICHIGAN AVE FL 13
CHICAGO IL
60603-6003
US

IV. Provider business mailing address

116 S MICHIGAN AVE FL 13
CHICAGO IL
60603-6003
US

V. Phone/Fax

Practice location:
  • Phone: 312-499-4288
  • Fax:
Mailing address:
  • Phone: 312-499-4288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277003881
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number233324
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041.383820
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: