Stults, Vanessa Marie
Stults, Vanessa Marie is an individual health care provider with primary practice located at 100 Springfield Ct , O Fallon IL 62269-2495. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Stults, Vanessa Marie can be contacted via phone (618) 632-3565.Contact Information
Primary practice address
100 Springfield Ct
O Fallon IL 62269-2495
Phone: (618) 632-3565
Fax: (618) 632-7693
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 085.003207 | Illinois |
Profile Details
| NPI number | 1689869588 |
|---|---|
| LBN Legal business name | Stults, Vanessa Marie |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 13th, 2007 |
| Last updated | Dec 28th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1689869588 | NPPES |
| Illinois | Other | 085.003207 | MEDICAL LICENSE |
| Illinois | Other | 5601005065 | MEDICAL LICENSE |
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