Individual
MARY STECH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-1212
(217) 366-6106
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3909
(217) 366-8107
(217) 366-6106
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209004442
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
433990
MEDICARE GROUP
IL
01
—
P00403926
RAILROAD MEDICARE
IL
Enumeration date
06/13/2006
Last updated
11/17/2014
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