Provider Demographics
NPI:1952109134
Name:VARICE, STACEYANN
Entity type:Individual
Prefix:
First Name:STACEYANN
Middle Name:
Last Name:VARICE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 S SHAG BARK TRL
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4327
Mailing Address - Country:US
Mailing Address - Phone:312-841-2849
Mailing Address - Fax:
Practice Address - Street 1:2417 S SHAG BARK TRL
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4327
Practice Address - Country:US
Practice Address - Phone:312-841-2849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL00000000000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily