| Provider / Organization | NPI | Date Certified |
|---|---|---|
| STEPHANIE ANGELA FAZLIBASIC | 1598247330 | 2024-04-05 |
Stephanie A Fazlibasic [F] graduated in 2017 and primarily specializes in Nurse Practitioner.
Stephanie Angela Fazlibasic is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1598247330. Registration indicates Stephanie Angela Fazlibasic is a provider of services with a specialization in Allopathic & Osteopathic Physicians, Family Medicine (Family Medicine: Hospice and Palliative Medicine, ) (Primary Care/Family Planning/APRN/PA, ) (Family Medicine Hospice and Palliative Medicine, Allopathic & Osteopathic Physicians) (Family Medicine, )
| PECOS ID | 547505174 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Stephanie Angela Fazlibasic |
| Practice Office Address | 2501 CHATHAM RD # 8288 SPRINGFIELD, IL US |
| Practice Office Telephone | 7732451932 |
| Mailing Address | 2501 CHATHAM RD # 8288 SPRINGFIELD, IL 627044188 US |
| Business Telephone | 7732451932 |
| Code | Practice | License No State |
|---|---|---|
| 207QH0002X PRIMARY | Allopathic & Osteopathic Physicians Family Medicine Family Medicine: Hospice and Palliative Medicine Primary Care/Family Planning/APRN/PA Family Medicine Hospice and Palliative Medicine Allopathic & Osteopathic Physicians Family Medicine | 209.017770
IL |
| 193200000X MULT | Group Code |