Provider Demographics
NPI:1730353186
Name:STEPHENS, DANA M (NP)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1909 N MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-1426
Mailing Address - Country:US
Mailing Address - Phone:309-263-9124
Mailing Address - Fax:309-266-8696
Practice Address - Street 1:1909 N MORTON AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1426
Practice Address - Country:US
Practice Address - Phone:309-263-9124
Practice Address - Fax:309-266-8696
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209004739363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics