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General NPI Number Information
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NPI Number | 1699422857
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Entity Type | Individual
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Provider Name | STACEY SEBASTIAN ARACKAL FNP
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Gender | Female
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Dates
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Enumeration Date | 03/08/2022
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Last Update Date | 03/08/2022
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Provider Practice Location Address
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Address Line | 5440 W BELMONT AVE
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City | CHICAGO
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State | IL
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Zip | 60641-4126
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Country | US
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Telephone | 773-286-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 555 GRACELAND AVE APT 305
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City | DES PLAINES
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State | IL
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Zip | 60016-7812
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Country | US
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Telephone | 847-287-1580
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.024068
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License Number State | IL
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