Provider Demographics
NPI:1588666093
Name:STEFANIW-GOTTLIEB, ROSEMARIE (PMHNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:STEFANIW-GOTTLIEB
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 WALNUT CT
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60081-8074
Mailing Address - Country:US
Mailing Address - Phone:847-899-9399
Mailing Address - Fax:
Practice Address - Street 1:100 N ATKINSON RD STE 106
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-7805
Practice Address - Country:US
Practice Address - Phone:888-211-8171
Practice Address - Fax:847-316-9797
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2025-06-25
Deactivation Date:2025-05-16
Deactivation Code:
Reactivation Date:2025-06-11
Provider Licenses
StateLicense IDTaxonomies
IL277.003947363LF0000X, 363LP0808X
IL209001367363LF0000X
IL277003947363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily