Provider Demographics
NPI:1316254287
Name:ROHER, STACY ANN (WHNP-BC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:ANN
Last Name:ROHER
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:ANN
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:900 N. 1ST STREET
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-3749
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:217-525-1007
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209011362363LW0102X
IL041-338805163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory