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General NPI Number Information
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NPI Number | 1588201719
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Entity Type | Individual
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Provider Name | STEPHANIE KAPA
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Gender | Female
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Dates
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Enumeration Date | 12/06/2019
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 4753 N BROADWAY SUITE 900, 910, 925
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City | CHICAGO
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State | IL
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Zip | 60640
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Country | US
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Telephone | 773-989-2780
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Fax |
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Provider Business Mailing Address
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Address Line | 2408 W RICE ST APT 302
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City | CHICAGO
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State | IL
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Zip | 60622-5212
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Country | US
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Telephone | 630-439-4996
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209.020566
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License Number State | IL
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