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General NPI Number Information
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NPI Number | 1619577657
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Entity Type | Individual
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Provider Name | NATALIE ANN STEPHENS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/28/2020
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Last Update Date | 10/28/2020
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Provider Practice Location Address
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Address Line | 800 NE GLEN OAK AVE
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City | PEORIA
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State | IL
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Zip | 61603-3255
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Country | US
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Telephone | 309-308-5072
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Fax | 309-308-5095
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Provider Business Mailing Address
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Address Line | 9166 US HIGHWAY 150
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City | CARLOCK
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State | IL
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Zip | 61725-7504
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Country | US
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Telephone | 630-254-8184
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 209021545
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License Number State | IL
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