Provider Demographics
NPI:1255808861
Name:LERNER, STACY ANNA (NP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANNA
Last Name:LERNER
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 1:1512 N SEDGWICK ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-8735
Mailing Address - Country:US
Mailing Address - Phone:314-265-7999
Mailing Address - Fax:
Practice Address - Street 1:259 E ERIE ST STE 1700
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3111
Practice Address - Country:US
Practice Address - Phone:312-695-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner