STAGES HEALTH & WELLNESS, LLC (NPI# 1417464918) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417464918 |
| Entity Type | Organization |
| Organization Name | STAGES HEALTH & WELLNESS, LLC |
| Practice Address |
14 Crabapple Lane Glen Carbon IL 62034 |
| Practice Telephone | 7086794927 |
| Practice Fax Number | 6185513449 |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2018-01-05 |
| Authorized Official Name | MS. MONIQUE L MANDERSON (CEO/FOUNDER) |
| Authorized Official Telephone | 7086794927 |
| Authorized Official Credential | FNP-C, PMHNP-BC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
2017038118 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
209.012605 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
14 CRABAPPLE LANE |
| City | GLEN CARBON |
| State | IL |
| Zip Code | 62034 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787795 | Kaleena Galletta | Nurse Practitioner | 4273 S., Il - 159, Glen Carbon, IL 62034 | 2018-04-06 |
| 1871092502 | Andrea Lee Sullivan | Dentist | 3024 South Il-159, Glen Carbon, IL 62034 | 2018-02-08 |
| 1700300498 | Michael Jay Arnold | Dentist | 3024 Il-159, Glen Carbon, IL 62034 | 2017-08-03 |
| 1679024228 | 360 Body Wellness Inc | Internal Medicine | 3407 Il State Route 157, Glen Carbon, IL 62034 | 2016-10-19 |
| 1346621505 | Stephanie N Lorts | Pediatrics | 4804 South State Route 159, Glen Carbon, IL 62034 | 2015-06-13 |
| 1205110111 | James Allan Staley | Pharmacist | #2 Cottonwood Rd, Glen Carbon, IL 62034 | 2011-10-11 |
| 1215224357 | Angela Eleni Kioultzopoulos | Speech-Language Pathologist | 7a Ginger Creek Village Dr., Glen Carbon, IL 62034 | 2011-07-08 |
| 1922320795 | Meridian Village Association | Skilled Nursing Facility | 27 Auerbach Place, Glen Carbon, IL 62034 | 2010-02-22 |
| 1679728356 | Erin Kathleen Immken | Counselor | 98 Junction Drive West, Suite 6, Glen Carbon, IL 62034 | 2008-11-24 |
| 1689886681 | Dental Professionals of Illinois, P.C. | Dentist | 4235 S State Road 159, Glen Carbon, IL 62034 | 2007-05-04 |
| Find all providers in zip 62034 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740787795 | Kaleena Galletta | Nurse Practitioner | 4273 S., Il - 159, Glen Carbon, IL 62034 | 2018-04-06 |
| 1437667490 | Spencer John Mares | Nurse Practitioner | 19 Junction Dr, Glen Carbon, IL 62034-4300 | 2018-01-11 |
| 1922514207 | Primary Healthcare Solutions, Inc | Nurse Practitioner | 17 Junction Dr # 271, Glen Carbon, IL 62034-4300 | 2017-12-21 |
| 1255853081 | Laurie Hopper | Nurse Practitioner | 2246 S State Route 157 Ste 100, Glen Carbon, IL 62034-1717 | 2017-07-13 |
| 1619360070 | Monique Manderson | Nurse Practitioner | 14 Crabapple Ln, Glen Carbon, IL 62034-3024 | 2015-03-10 |
| 1548719651 | Ashley Renee Noeth | Nurse Practitioner | 4955 S State Route 159, Suite 1, Glen Carbon, IL 62034-1907 | 2016-09-30 |
| 1689915811 | Jaime Renee Mendoza | Nurse Practitioner | 16 Junction Dr W, Ste 2, Glen Carbon, IL 62034-2996 | 2013-03-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538760277 | Jennifer Michelle Kennedy | Nurse Practitioner | 3006 Lakeview Dr, Metropolis, IL 62960-3119 | 2020-11-07 |
| 1881295541 | Britney Julia Durst | Nurse Practitioner | 5905 N Prospect Rd, Peoria, IL 61614-4311 | 2020-11-07 |
| 1952902884 | Julia Ann Gottschalk | Nurse Practitioner | 1979 Mcdowell Rd, Unit 103, Naperville, IL 60563 | 2020-11-06 |
| 1932700911 | Laura Ivette Portillo | Nurse Practitioner | 2727 N Marmora Ave, Chicago, IL 60639-1219 | 2020-11-05 |
| 1265033385 | Carolle M Derradji | Nurse Practitioner | 3256 W Potomac Ave, Chicago, IL 60651-2411 | 2020-11-04 |
| 1104427293 | Katie Michelle O'halloran | Nurse Practitioner | 5841 S Maryland Ave # E500, Chicago, IL 60637-1443 | 2020-11-04 |
| 1598365140 | Caitlyn Windsor | Nurse Practitioner | 24525 Grange Rd, Geneseo, IL 61254-8429 | 2020-10-31 |
| 1578163515 | Deanna Bassette | Nurse Practitioner | 243 E 31st St Apt 401, Chicago, IL 60616-5212 | 2020-10-29 |
| 1891395745 | Vrunda Shah Patel | Nurse Practitioner | 933 W Van Buren St Apt 502, Chicago, IL 60607-3583 | 2020-10-29 |
| 1346840337 | Catherine Suh | Nurse Practitioner | 1380 Marcy Ln, Wheeling, IL 60090-4422 | 2020-10-28 |
| Find all providers with the same taxonomy | ||||
| City | GLEN CARBON |
| Zip Code | 62034 |
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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.