Provider Demographics
NPI:1003182940
Name:COMRIE, STEPHANIE A (RN/BSN, MSN ,FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:A
Last Name:COMRIE
Suffix:
Gender:F
Credentials:RN/BSN, MSN ,FNP-BC
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:KLOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 HEALTHCARE DRIVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1155
Mailing Address - Country:US
Mailing Address - Phone:618-664-1380
Mailing Address - Fax:618-664-4239
Practice Address - Street 1:201 HEALTHCARE DRIVE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1155
Practice Address - Country:US
Practice Address - Phone:618-664-1380
Practice Address - Fax:618-664-4239
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041363807163W00000X
IL209009503363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily