Healthcare Provider Details

I. General information

NPI: 1730594037
Provider Name (Legal Business Name): STEPHANIE R RINEHART
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2014
Last Update Date: 06/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 S MAIN ST
EUREKA IL
61530-1666
US

IV. Provider business mailing address

1932 S MAIN ST
EUREKA IL
61530-1666
US

V. Phone/Fax

Practice location:
  • Phone: 309-467-5000
  • Fax: 309-467-5100
Mailing address:
  • Phone: 309-467-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberUNKNOWN
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: