Individual
STACY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSN RN
Contact information
Practice address
1900 E MAIN ST, DANVILLE, IL 61832-5100
(217) 554-3000
Mailing address
1103 FOOTHILL DR, CHAMPAIGN, IL 61821-5620
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
041409721
IL
Other
Enumeration date
05/23/2023
Last updated
05/23/2023
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