Provider Demographics
NPI:1588666093
Name:STEFANIW-GOTTLIEB, ROSEMARIE (APRN BC)
Entity type:Individual
Prefix:MS
First Name:ROSEMARIE
Middle Name:
Last Name:STEFANIW-GOTTLIEB
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:MS
Other - First Name:ROSEMARIE
Other - Middle Name:S
Other - Last Name:GOTTLIEB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN BC
Mailing Address - Street 1:132 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1577
Mailing Address - Country:US
Mailing Address - Phone:630-788-2131
Mailing Address - Fax:630-237-6020
Practice Address - Street 1:132 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-1577
Practice Address - Country:US
Practice Address - Phone:630-788-2131
Practice Address - Fax:630-237-6020
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2025-06-11
Deactivation Date:2025-05-16
Deactivation Code:
Reactivation Date:2025-06-11
Provider Licenses
StateLicense IDTaxonomies
IL041-264733163W00000X
IL206-001367363L00000X
IL209001367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner