Individual
MRS. STEPHANIE PEARLETTE POWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 E 51ST ST, ROOM 7021E, CHICAGO, IL 60615-2400
(312) 572-2743
(312) 572-2799
Mailing address
500 E 51ST ST, ROOM 7021E, CHICAGO, IL 60615-2400
(773) 572-2743
(773) 572-2799
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-001414
IL
363AM0700X
Medical Physician Assistant
085-001414
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085001414
PA LICENSE NUMBER
IL
Enumeration date
10/02/2006
Last updated
04/28/2021
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