Healthcare Provider Details

I. General information

NPI: 1689626095
Provider Name (Legal Business Name): STEPHANIE FRANKLIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 US HIGHWAY 45 N
ELDORADO IL
62930-3767
US

IV. Provider business mailing address

PO BOX 3988
CARBONDALE IL
62902-3988
US

V. Phone/Fax

Practice location:
  • Phone: 618-273-7723
  • Fax: 618-351-4834
Mailing address:
  • Phone: 618-457-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209002554
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: