Provider Demographics
NPI:1700275997
Name:STAMMER, STEVEN ERIC (NP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ERIC
Last Name:STAMMER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 COUNTY ROAD 2545 E
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:IL
Mailing Address - Zip Code:61859-9787
Mailing Address - Country:US
Mailing Address - Phone:217-369-6174
Mailing Address - Fax:
Practice Address - Street 1:1377 COUNTY ROAD 2545 E
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:IL
Practice Address - Zip Code:61859-9787
Practice Address - Country:US
Practice Address - Phone:217-369-6174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.012342363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health