Individual
ANU J STEPHEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12251 S 80TH AVE, PALOS HEIGHTS, IL 60463-1256
(630) 257-1111
(630) 257-1115
Mailing address
12251 S 80TH AVE STE 1630, PALOS HEIGHTS, IL 60463-1256
(708) 923-5173
(708) 923-5018
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209021186
IL
363LP2300X
Primary Care Nurse Practitioner
209021186
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
332023626001
—
IL
Enumeration date
08/14/2020
Last updated
08/28/2020
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