Healthcare Provider Details

I. General information

NPI: 1619739448
Provider Name (Legal Business Name): STEPHANIE DESALVO ACNP-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE STUDER ACNP-AG

II. Dates (important events)

Enumeration Date: 01/26/2024
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-8000
  • Fax:
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16918-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209028240
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number209028240
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: