Healthcare Provider Details

I. General information

NPI: 1649692435
Provider Name (Legal Business Name): STEPHANIE MENSCH APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2014
Last Update Date: 01/13/2014
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

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

V. Phone/Fax

Practice location:
  • Phone: 312-213-8897
  • Fax: 708-684-4446
Mailing address:
  • Phone: 312-213-8897
  • Fax: 708-684-4446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number209.010538
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: