Provider Demographics
NPI:1609154699
Name:ROBERTS, STEPHEN E, (PHD, RN)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:E,
Last Name:ROBERTS
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Gender:M
Credentials:PHD, RN
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Mailing Address - Street 1:2153 S. 1ST AVENUE
Mailing Address - Street 2:MAGUIRE BUILDING ROOM 1900
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-6808
Mailing Address - Fax:708-216-3565
Practice Address - Street 1:2153 S. 1ST AVENUE
Practice Address - Street 2:MAGUIRE BUILDING ROOM 1900
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-0005
Practice Address - Fax:708-216-4948
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209-001230163WN0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0800XNursing Service ProvidersRegistered NurseNeuroscience