Provider Demographics
NPI:1902978976
Name:STINE, JO SUE (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:JO
Middle Name:SUE
Last Name:STINE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ELMO
Mailing Address - State:IL
Mailing Address - Zip Code:62458-1635
Mailing Address - Country:US
Mailing Address - Phone:618-829-3991
Mailing Address - Fax:618-829-3991
Practice Address - Street 1:302 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT ELMO
Practice Address - State:IL
Practice Address - Zip Code:62458-1635
Practice Address - Country:US
Practice Address - Phone:618-829-3991
Practice Address - Fax:618-829-3991
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041162405163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse