MEDICARE: STACEY L ZARNSTORFF GREEN APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	041-265243	IL

General Provider Information

NPI Number	:	1245243369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY L ZARNSTORFF GREEN APN

Provider Business Mailing Address
First Line	:	4719 CONCORD LN
Second Line	:
City	:	RICHMOND
State	:	IL
Zip	:	60071-9010
Country	:	US
Telephone Number	:	815-669-4228
Fax Number	:

Provider Business Practice Location Address
First Line	:	4719 CONCORD LN
Second Line	:
City	:	RICHMOND
State	:	IL
Zip	:	60071-9010
Country	:	US
Telephone Number	:	815-669-4228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	11/29/2021

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