Provider Demographics
NPI:1396880266
Name:BURRELL, STEPHANIE JAVUE (LPN)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JAVUE
Last Name:BURRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:1810 W S 3RD ST
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62565-9205
Mailing Address - Country:US
Mailing Address - Phone:217-774-2113
Mailing Address - Fax:217-774-2256
Practice Address - Street 1:1810 W S 3RD ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-9205
Practice Address - Country:US
Practice Address - Phone:217-774-2113
Practice Address - Fax:217-774-2256
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse