Individual
STACYE KELLERMANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1740 W TAYLOR ST STE 3200W, CHICAGO, IL 60612-7232
(312) 996-4022
Mailing address
31 BLONDELL CT, LUTHERVILLE, MD 21093-2003
(443) 845-3232
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209.017235
IL
Other
Enumeration date
02/07/2018
Last updated
02/07/2018
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