Provider Demographics
NPI:1114388543
Name:MCGEORGE, STEPHANIE JO (BSN RN CNOR RNFA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:MCGEORGE
Suffix:
Gender:F
Credentials:BSN RN CNOR RNFA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:104 E ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT ZION
Mailing Address - State:IL
Mailing Address - Zip Code:62549-1271
Mailing Address - Country:US
Mailing Address - Phone:217-864-2665
Mailing Address - Fax:217-330-5571
Practice Address - Street 1:104 E ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:MOUNT ZION
Practice Address - State:IL
Practice Address - Zip Code:62549-1271
Practice Address - Country:US
Practice Address - Phone:217-864-2665
Practice Address - Fax:217-330-5571
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-12
Last Update Date:2016-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.320680163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic