Provider Demographics
NPI:1841408515
Name:STESAL, NELYA (NP)
Entity Type:Individual
Prefix:
First Name:NELYA
Middle Name:
Last Name:STESAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 GROSS POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:847-679-3411
Mailing Address - Fax:847-675-7450
Practice Address - Street 1:9555 GROSS POINT ROAD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076
Practice Address - Country:US
Practice Address - Phone:847-679-3411
Practice Address - Fax:847-675-7450
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209005900OtherSTATE LICENSE
IL363L00000XOtherTAX CODE