Individual
MR. ILYA O STAGNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
114 E SOUTH HILLS DR, MARYVILLE, MO 64468-2659
(660) 562-4304
(660) 562-4308
Mailing address
114 E SOUTH HILLS DR, MARYVILLE, MO 64468-2659
(660) 562-4304
(660) 562-4308
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
80603
KS
363LF0000X
Family Nurse Practitioner
Primary
2024009165
MO
Other
Enumeration date
10/11/2021
Last updated
04/17/2025
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