Provider Demographics
NPI:1265063192
Name:CLONINGER-HULTZ, STEPHANNIE (APRN FNP-C FPA)
Entity type:Individual
Prefix:
First Name:STEPHANNIE
Middle Name:
Last Name:CLONINGER-HULTZ
Suffix:
Gender:F
Credentials:APRN FNP-C FPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GLEN ED PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GLEN CARBON
Mailing Address - State:IL
Mailing Address - Zip Code:62034-3333
Mailing Address - Country:US
Mailing Address - Phone:618-221-9596
Mailing Address - Fax:
Practice Address - Street 1:9 GLEN ED PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GLEN CARBON
Practice Address - State:IL
Practice Address - Zip Code:62034-3333
Practice Address - Country:US
Practice Address - Phone:618-221-9596
Practice Address - Fax:618-551-8729
Is Sole Proprietor?:No
Enumeration Date:2020-01-29
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL277003321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily