Provider Demographics
NPI:1811486350
Name:STIVERS, STEPHANIE SUEANN (CNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SUEANN
Last Name:STIVERS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 S ROUTE 51
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:IL
Mailing Address - Zip Code:62535-9809
Mailing Address - Country:US
Mailing Address - Phone:217-823-9190
Mailing Address - Fax:
Practice Address - Street 1:845 S ROUTE 51
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:IL
Practice Address - Zip Code:62535
Practice Address - Country:US
Practice Address - Phone:217-875-0953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209017598363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily