MEDICARE: MRS. STEPHANIE ANN ROMER ADVANCED PRACTICE NU

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	363LW0102X	Women's Health Nurse Practitioner	209003157	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	04923240	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1922097328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STEPHANIE ANN ROMER ADVANCED PRACTICE NU

Provider Business Mailing Address
First Line	:	27750 W HIGHWAY 22
Second Line	:	STE 120
City	:	BARRINGTON
State	:	IL
Zip	:	60010-2379
Country	:	US
Telephone Number	:	847-277-0500
Fax Number	:	847-277-0505

Provider Business Practice Location Address
First Line	:	27750 W HIGHWAY 22
Second Line	:	STE 120
City	:	BARRINGTON
State	:	IL
Zip	:	60010-2379
Country	:	US
Telephone Number	:	847-277-0500
Fax Number	:	847-277-0505

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	04/02/2013

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