Provider Demographics
NPI:1376904458
Name:STUVLAND, KIERRA (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:KIERRA
Middle Name:
Last Name:STUVLAND
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:KIERRA
Other - Middle Name:AMANDA
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2314 W HURON ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-1206
Mailing Address - Country:US
Mailing Address - Phone:847-644-8587
Mailing Address - Fax:
Practice Address - Street 1:1701 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-5646
Practice Address - Country:US
Practice Address - Phone:312-666-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-16
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL104106320363LW0102X
ILCNM07665367A00000X
374J00000X
IL367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No374J00000XNursing Service Related ProvidersDoula