Provider Demographics
NPI:1457942385
Name:NINO, STEPHANIE (CPHT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:NINO
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60505-4313
Mailing Address - Country:US
Mailing Address - Phone:630-765-1767
Mailing Address - Fax:
Practice Address - Street 1:355 N EOLA RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9684
Practice Address - Country:US
Practice Address - Phone:630-585-9417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183700000X
IL049.243686183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician