Individual
STEPHANIE MOULTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4440 W 95TH ST, OAK LAWN, IL 60453-2600
(708) 684-5400
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
209.032424
IL
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
209032424
IL
Other
Enumeration date
06/12/2025
Last updated
11/26/2025
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