Provider Demographics
NPI:1093156408
Name:BAKOSH, STEPHANIE JEAN (MSN, ANP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JEAN
Last Name:BAKOSH
Suffix:
Gender:F
Credentials:MSN, ANP-BC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3450 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2331
Mailing Address - Country:US
Mailing Address - Phone:602-265-8338
Mailing Address - Fax:602-265-8533
Practice Address - Street 1:201 E OGDEN AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3633
Practice Address - Country:US
Practice Address - Phone:630-995-9905
Practice Address - Fax:630-995-9905
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-13
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.010432363LA2200X
AZ240748363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health