=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730739467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANIE BELL MSN, APRN, AGNP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2019
-----------------------------------------------------
Last Update Date | 06/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2407 CORPORATE CTR STE C
-----------------------------------------------------
City | GRANITE CITY
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62040-4268
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-334-6309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 918 TIMBERLAKE DR
-----------------------------------------------------
City | EDWARDSVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62025-4107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 618-334-6309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | AG09190098
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------