Provider Demographics
NPI:1255098786
Name:BRANCHEAU, STEPHANIE (APRN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BRANCHEAU
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 RAYMOND DR STE 205
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9791
Mailing Address - Country:US
Mailing Address - Phone:630-717-2300
Mailing Address - Fax:630-717-9638
Practice Address - Street 1:636 RAYMOND DR STE 205
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9791
Practice Address - Country:US
Practice Address - Phone:630-717-2300
Practice Address - Fax:630-717-9638
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023605363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209023605Medicaid