Provider Demographics
NPI:1871702381
Name:STEPHENS, PAMELA ANN I (LPN)
Entity type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:ANN
Last Name:STEPHENS
Suffix:I
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1602 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK FALLS
Mailing Address - State:IL
Mailing Address - Zip Code:61071-2809
Mailing Address - Country:US
Mailing Address - Phone:815-626-3683
Mailing Address - Fax:
Practice Address - Street 1:1602 6TH AVE
Practice Address - Street 2:
Practice Address - City:ROCK FALLS
Practice Address - State:IL
Practice Address - Zip Code:61071-2809
Practice Address - Country:US
Practice Address - Phone:815-626-3683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse