Provider Demographics
NPI:1578764353
Name:STEFFEN, MARY L (CNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:STEFFEN
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:1919 S HIGHLAND AVE
Mailing Address - Street 2:SUITE A230 ATTN. RAYLENE BOYD
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6153
Mailing Address - Country:US
Mailing Address - Phone:630-873-7305
Mailing Address - Fax:630-416-3189
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:DOB 3 SUITE 3200
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1019
Practice Address - Country:US
Practice Address - Phone:847-882-8448
Practice Address - Fax:847-882-8481
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209003949363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL602930010Medicare PIN