Provider Demographics
NPI:1063728202
Name:STOUFFER, EMILY N (NP-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:N
Last Name:STOUFFER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:N
Other - Last Name:DITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1611 W HARRISON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4861
Mailing Address - Country:US
Mailing Address - Phone:312-243-4244
Mailing Address - Fax:312-942-1517
Practice Address - Street 1:1611 W HARRISON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4861
Practice Address - Country:US
Practice Address - Phone:312-243-4244
Practice Address - Fax:312-942-1517
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.008183363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL604530OtherPTAN LOCALITY 16
IL1633878OtherBCBS IL
IL202735OtherPTAN LOCALITY 15
IL215827OtherPTAN LOCALITY 99