Provider Demographics
NPI:1649575697
Name:MARTLINK, STEFANIE NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:NICOLE
Last Name:MARTLINK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:NICOLE
Other - Last Name:KOCOUREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2900 KIRK RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-6015
Mailing Address - Country:US
Mailing Address - Phone:630-933-2550
Mailing Address - Fax:630-933-2558
Practice Address - Street 1:2900 KIRK RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-6015
Practice Address - Country:US
Practice Address - Phone:630-933-2550
Practice Address - Fax:630-933-2558
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209008199363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5966OtherMEDICARE PTAN (INDIVIDUAL)
ILIL7268004OtherMEDICARE PTAN (INDIVIDUAL)
ILIL5966007OtherMEDICARE PTAN (GROUP)
ILIL5966OtherMEDICARE PTAN (INDIVIDUAL)