Healthcare Provider Details

I. General information

NPI: 1558319616
Provider Name (Legal Business Name): STACEY A OBERMEYER APN-CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E BRUSH HILL RD
ELMHURST IL
60126-5658
US

IV. Provider business mailing address

2650 RIDGE AVE STE 1223
EVANSTON IL
60201-1700
US

V. Phone/Fax

Practice location:
  • Phone: 847-982-3172
  • Fax:
Mailing address:
  • Phone:
  • Fax: 224-654-0000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number209001929
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: