Individual
MS. STACEY K ROLINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1775 DEMPSTER ST, PARK RIDGE, IL 60068-1143
(847) 723-2210
(847) 692-7915
Mailing address
1775 DEMPSTER ST, PARK RIDGE, IL 60068-1143
(847) 723-2210
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085.004160
IL
Other
Enumeration date
01/17/2012
Last updated
01/17/2012
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