Individual
STACY A. VANVLEET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2400 N ROCKTON AVE, ROCKFORD, IL 61103-3655
(815) 971-5000
Mailing address
2400 N ROCKTON AVE, ROCKFORD, IL 61103-3655
(815) 971-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209-002958
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NON PAR
—
IL
Enumeration date
12/12/2006
Last updated
04/12/2016
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