Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209009503 | IL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 209009503 | IL |
NPI | 1003182940 |
---|---|
Provider Name | Mrs. Stephanie A Comrie |
First Address | Greenville, IL 62246-1155 |
Second Address | Greenville, IL 62246-1155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 17/12/2021 |