Healthcare Provider Details

I. General information

NPI: 1558459099
Provider Name (Legal Business Name): STEVEN R STAKENAS APRN, CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 W 75TH ST STE 101
NAPERVILLE IL
60540-9311
US

IV. Provider business mailing address

245 S GARY AVE STE 100
BLOOMINGDALE IL
60108-2200
US

V. Phone/Fax

Practice location:
  • Phone: 630-646-7000
  • Fax: 305-481-5636
Mailing address:
  • Phone: 630-933-4550
  • Fax: 630-933-2200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209-006058
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209006058
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: