Provider Demographics
NPI:1144593450
Name:NEILL, STEFANIE ANN (NP)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:ANN
Last Name:NEILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:ANN
Other - Last Name:SCHWENTKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 NW RD MIZE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014
Mailing Address - Country:US
Mailing Address - Phone:816-220-1117
Mailing Address - Fax:816-228-2053
Practice Address - Street 1:203 NW RD MIZE RD STE 200
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014
Practice Address - Country:US
Practice Address - Phone:816-220-1117
Practice Address - Fax:816-228-2053
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012004404363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner