Healthcare Provider Details

I. General information

NPI: 1669358396
Provider Name (Legal Business Name): STEFANIE NICOLE FISCHER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 OFFICE CT
FAIRVIEW HEIGHTS IL
62208-2059
US

IV. Provider business mailing address

16511 WILD HORSE CREEK RD APT 471
CHESTERFIELD MO
63017-1445
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-7666
  • Fax:
Mailing address:
  • Phone: 636-236-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2025014129
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: