Basic Information
| Provider Information | |||||||||
| NPI: | 1962749887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PADLEY | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 307 S EVERGREEN AVE | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080962739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8566864316 | ||||||||
| FaxNumber: | 8568488536 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 BISTERFIELD ROAD | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600070000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8474375500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2013 | ||||||||
| LastUpdateDate: | 01/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 041357166 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.