Provider Demographics
NPI:1700282076
Name:STOUT, MARCIA (DNP, APN, FNP-C)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:
Last Name:STOUT
Suffix:
Gender:F
Credentials:DNP, APN, FNP-C
Other - Prefix:DR
Other - First Name:MARCIA
Other - Middle Name:
Other - Last Name:STOUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, APN, FNP-C
Mailing Address - Street 1:1030 N STATE ST
Mailing Address - Street 2:UNIT 5 L
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-5476
Mailing Address - Country:US
Mailing Address - Phone:312-282-9919
Mailing Address - Fax:
Practice Address - Street 1:1030 N STATE ST
Practice Address - Street 2:UNIT 5 L
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-5476
Practice Address - Country:US
Practice Address - Phone:312-282-9919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily