Healthcare Provider Details

I. General information

NPI: 1881823003
Provider Name (Legal Business Name): PATRICE ANN STEPHENS MS, APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 07/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

7834 W FORESTHILL CT UNIT 1DR
PALOS HEIGHTS IL
60463-2769
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5849
  • Fax: 708-684-4369
Mailing address:
  • Phone: 708-671-5408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number041-198420
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: