Individual
STACEY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP-BC
Contact information
Practice address
1010 LAKE ST STE 100, OAK PARK, IL 60301-1106
(708) 790-5200
Mailing address
1137 W 127TH ST, CALUMET PARK, IL 60827-6537
(708) 620-7807
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209.022618
IL
Other
Enumeration date
01/06/2021
Last updated
03/12/2021
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