Provider Demographics
NPI:1699422857
Name:ARACKAL, STACEY SEBASTIAN (FNP)
Entity type:Individual
Prefix:MS
First Name:STACEY
Middle Name:SEBASTIAN
Last Name:ARACKAL
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 1:555 GRACELAND AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-7812
Mailing Address - Country:US
Mailing Address - Phone:847-287-1580
Mailing Address - Fax:
Practice Address - Street 1:5440 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4126
Practice Address - Country:US
Practice Address - Phone:773-286-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.024068363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily