Provider Demographics
NPI:1972799930
Name:CIRCELLI, STACY J (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:J
Last Name:CIRCELLI
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HEALTH SERVICES DR
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-9600
Mailing Address - Country:US
Mailing Address - Phone:815-756-5255
Mailing Address - Fax:815-756-9944
Practice Address - Street 1:10 HEALTH SERVICES DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9600
Practice Address - Country:US
Practice Address - Phone:815-756-5255
Practice Address - Fax:815-756-9944
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209001924363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK48618Medicare PIN
ILK48617Medicare PIN