Provider Demographics
NPI:1508319914
Name:PILLER, STACY A (APN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:PILLER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:A
Other - Last Name:KNAPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 E 12TH ST
Mailing Address - Street 2:STE 600
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-9010
Mailing Address - Country:US
Mailing Address - Phone:815-538-7200
Mailing Address - Fax:815-539-1444
Practice Address - Street 1:1405 E 12TH ST
Practice Address - Street 2:STE 600
Practice Address - City:MENDOTA
Practice Address - State:IL
Practice Address - Zip Code:61342-9010
Practice Address - Country:US
Practice Address - Phone:815-538-7200
Practice Address - Fax:815-539-1444
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041289414163W00000X
IL209-014728363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse