Healthcare Provider Details

I. General information

NPI: 1134115611
Provider Name (Legal Business Name): STACY LYNNE BICHL APN-CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE #43
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6263
  • Fax: 312-227-9420
Mailing address:
  • Phone: 312-227-6263
  • Fax: 312-227-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209-004592
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: