Provider Demographics
NPI:1598216657
Name:GILE, STEPHANIE MICHELLE (APN)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:MICHELLE
Last Name:GILE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 ROXBURY RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5089
Mailing Address - Country:US
Mailing Address - Phone:815-227-8300
Mailing Address - Fax:
Practice Address - Street 1:612 ROXBURY RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5089
Practice Address - Country:US
Practice Address - Phone:815-227-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILAG1016086OtherAANP CERTIFICATION NUMBER