Basic Information
Provider Information
NPI: 1093147043
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALMAROAD
FirstName: STEPHANIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN, CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: FREEMAN
OtherFirstName: STEPHANIE
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: APRN, CRNA
OtherLastNameType: 1
Mailing Information
Address1: 611 W PARK ST
Address2:  
City: URBANA
State: IL
PostalCode: 618012500
CountryCode: US
TelephoneNumber: 2173836792
FaxNumber: 2173834752
Practice Location
Address1: 602 W UNIVERSITY AVE
Address2:  
City: URBANA
State: IL
PostalCode: 618012530
CountryCode: US
TelephoneNumber: 2173833303
FaxNumber: 2173833265
Other Information
ProviderEnumerationDate: 08/01/2013
LastUpdateDate: 05/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X209010554ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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