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General NPI Number Information
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NPI Number | 1366172645
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Entity Type | Individual
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Provider Name | CHRISTINA ANN STOLLER AGPCNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/10/2022
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 550 30TH AVE STE 12
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City | MOLINE
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State | IL
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Zip | 61265-5975
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Country | US
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Telephone | 309-277-1461
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Fax | 309-736-1152
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Provider Business Mailing Address
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Address Line | 550 30TH AVE STE 12
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City | MOLINE
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State | IL
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Zip | 61265-5975
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Country | US
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Telephone | 309-277-1461
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Fax | 309-736-1152
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 041.399791
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 209.025316
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 209025316
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License Number State | IL
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