Provider Demographics
NPI:1568485464
Name:ARENS, STACY LYNN (PA-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:ARENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3623 N PINE GROVE AVE APT 3E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-5327
Mailing Address - Country:US
Mailing Address - Phone:773-301-6675
Mailing Address - Fax:312-572-4659
Practice Address - Street 1:1901 W HARRISON ST
Practice Address - Street 2:JOHN H. STROGER HOSPITAL/THE CORE CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-572-4675
Practice Address - Fax:312-572-4659
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant