Healthcare Provider Details

I. General information

NPI: 1043949951
Provider Name (Legal Business Name): STEPHANIE DANIELLE PEARSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N MAIN ST
WHEATON IL
60187-3112
US

IV. Provider business mailing address

1800 N MAIN ST
WHEATON IL
60187-3112
US

V. Phone/Fax

Practice location:
  • Phone: 630-260-0600
  • Fax:
Mailing address:
  • Phone: 630-260-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number125.079837
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: