Healthcare Provider Details

I. General information

NPI: 1316254287
Provider Name (Legal Business Name): STACY ANN ROHER WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY ANN LYNCH RN

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 N. 1ST STREET
SPRINGFIELD IL
62702-3749
US

IV. Provider business mailing address

1025 S 6TH ST
SPRINGFIELD IL
62703-2403
US

V. Phone/Fax

Practice location:
  • Phone: 217-528-7541
  • Fax: 217-525-1007
Mailing address:
  • Phone: 217-528-7541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number209011362
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number041-338805
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: