Healthcare Provider Details

I. General information

NPI: 1336652700
Provider Name (Legal Business Name): STACEY JO CALER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 FINANCIAL CT UNIT 300
ROCKFORD IL
61107-6671
US

IV. Provider business mailing address

333 N SUMMIT STREET 7TH FLOOR HCR MANORCARE MEDICAL SERVICES OF FLORIDA, LLC
TOLEDO OH
43604-2615
US

V. Phone/Fax

Practice location:
  • Phone: 800-427-1902
  • Fax:
Mailing address:
  • Phone: 419-252-6031
  • Fax: 800-564-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.016830
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: