STACEY BOETTO (NPI# 1104334945) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104334945 |
| Entity Type | Individual |
| Full Name | STACEY BOETTO |
| Credential | FNP-C |
| Practice Address |
303 N Raven Rd Shorewood IL 60404-9639 |
| Practice Telephone | 8155464575 |
| Mailing Telephone | 8155464575 |
| Enumeration Date | 2018-01-15 |
| Last Update Date | 2020-03-01 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 277000185 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | 209.017015 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
209.017015 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 303 N Raven Rd, Shorewood, IL 604049639 | 8155464575 |
| Street Address |
303 N RAVEN RD |
| City | SHOREWOOD |
| State | IL |
| Zip Code | 60404-9639 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669035242 | Mobile Dental Care of Delaware, Pa | Dentist | 18622 S. Rte 59 Unit A-1, Shorewood, IL 60404 | 2019-04-18 |
| 1326476755 | Christine Briski | Speech-Language Pathologist | 210 W Black Road, Shorewood, IL 60404 | 2013-10-22 |
| 1598000630 | Michael G Mcdowell | Nurse Practitioner | 1039 Brookforest Ave, Shorewood, IL 60404 | 2012-11-29 |
| 1699028910 | Patti-ann Ebert | Occupational Therapist | 850 Brook Forest Ave., Unit L, Shorewood, IL 60404 | 2012-10-24 |
| 1043567720 | Matthew Reiot Klebenow | Occupational Therapist | 852a Sharp Drive, Provena Physical Therapy & Industrial Rehab. Center, Shorewood, IL 60404 | 2012-08-13 |
| 1366728222 | Linda K Alonso | Pharmacist | 1160 W. Jefferson St., Shorewood, IL 60404 | 2011-10-24 |
| 1205110186 | Lanie R Moreno | Physical Therapist | 850 Brookforest Ave Unit L, Shorewood, IL 60404 | 2011-10-10 |
| 1932386810 | Advanced Family Dental of Shorewood, P.C. | Dentist | 150 N Brook Forest Drive, Shorewood, IL 60404 | 2008-01-23 |
| 1003025941 | Kerri Lanum | Specialist/Technologist | 850 Brookforest Ave. F, Shorewood, IL 60404 | 2007-05-21 |
| 1124246756 | Alexander Grabavoy | Dentist | 1007 W. Jefferson Street, Shorewood, IL 60404 | 2007-04-20 |
| Find all providers in zip 60404 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619501426 | Claudia Heald | Nurse Practitioner | 21052 Kenmare Dr, Shorewood, IL 60404-6098 | 2020-03-02 |
| 1679961742 | A Plus Healthcare Management LLC | Nurse Practitioner | 1039 Brook Forest Ave, Shorewood, IL 60404-8849 | 2014-12-24 |
| 1275093544 | Jennifer Yanak | Nurse Practitioner | 1039 Brookforest Ave, Shorewood, IL 60404-8849 | 2019-03-22 |
| 1134516479 | Ryan Braner | Nurse Practitioner | 1039 Brookforest Ave, Shorewood, IL 60404 | 2015-04-24 |
| 1811237977 | Kristen Howell Owens | Nurse Practitioner | 1039 Brookforest Ave, Shorewood, IL 60404 | 2013-02-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619578523 | Kaitlin Lawson Kalnitz | Nurse Practitioner | 745 Mcclintock Dr Ste 360, Burr Ridge, IL 60527-0875 | 2020-11-06 |
| 1841890290 | Maria Malanych | Nurse Practitioner | 5731 Rosinweed Ln, Naperville, IL 60564-1635 | 2020-10-27 |
| 1639778160 | Roxanna Lee Gunnels | Nurse Practitioner | 1 Bronze Pointe Plaza Suite 1a, Swansea, IL 62226 | 2020-10-26 |
| 1295334811 | Mary Farley | Nurse Practitioner | 7308 Northwood Dr, Wonder Lake, IL 60097-8606 | 2020-10-24 |
| 1164021168 | Stephanie Schuster | Nurse Practitioner | 2665 Prairieview Ln N, Aurora, IL 60502-6343 | 2020-10-21 |
| 1316546641 | Vanessa K Bajaj | Nurse Practitioner | 1123 N Claremont Dr, Palatine, IL 60074-4002 | 2020-10-19 |
| 1003414442 | Gachugu Medical Clinic | Nurse Practitioner | 1 E Ferguson Ave, Wood River, IL 62095-1903 | 2020-10-16 |
| 1477151272 | Yolanda K Bradford | Nurse Practitioner | 2700 S California Ave, Chicago, IL 60608-5108 | 2020-10-14 |
| 1265030019 | Andrea Mclean | Nurse Practitioner | 2500 W Reynolds St # 205, Pontiac, IL 61764-9774 | 2020-10-14 |
| 1558968628 | Timothy Nenoff | Nurse Practitioner | 24722 Lincolnway St, Plainfield, IL 60544-2412 | 2020-10-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.