Provider Demographics
NPI:1104329036
Name:NAGARWALLA, STEPHANIE SUE (FNP)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:SUE
Last Name:NAGARWALLA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 WILDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-5012
Mailing Address - Country:US
Mailing Address - Phone:630-802-6966
Mailing Address - Fax:
Practice Address - Street 1:1600 N RANDALL RD STE 400
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-7805
Practice Address - Country:US
Practice Address - Phone:847-381-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.017356363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner