MRS. STEPHANIE M ELLIS


Address: 4909 N Glen Park Place Rd, Peoria, IL 61614-4676
Phone: 3096747546

MRS. STEPHANIE M ELLIS (NPI# 1922313238) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1922313238
Entity Type Individual
Full Name MRS. STEPHANIE M ELLIS
Credential PA
Practice Address 4909 N Glen Park Place Rd
Peoria
IL 61614-4676
Practice Telephone 3096747546
Practice Fax Number 3092820500
Mailing Telephone 3096747546
Mailing Fax Number 3092820500
Enumeration Date 2010-08-11
Last Update Date 2010-08-11
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363A00000X Physician Assistant IL Physician Assistants & Advanced Practice Nursing Providers

Other Providers STEPHANIE ELLIS

NPI Name Taxonomy Address Enumeration
1578102901 Stephanie Nicole Ellis Speech-Language Pathologist 1101 Museum Rd Ste 7, Conway, AR 72032-8580 2020-01-02
1992147219 Stephanie Rachel Ellis Pharmacist 318 Mall Blvd Ste 100, Savannah, GA 31406-4700 2013-07-28
1609914217 Stephanie Clark Ellis Acupuncturist 110 Creek Locks Rd, Rosendale, NY 12472-9678 2007-02-03
1922617224 Stephanie Lynn Ellis Nurse Practitioner 232 Green St, Williamston, NC 27892-2000 2020-07-23
1942826789 Stephanie Jo Ellis Counselor 1340 Mount Pleasant St, Burlington, IA 52601-2623 2020-06-17
1497393268 Stephanie Knight Ellis Pharmacist 450 Northside Cherokee Blvd, Canton, GA 30115-8015 2019-12-12
1992351209 Stephanie Ellis Nurse Practitioner 110 Hidden Valley Rd, Mc Murray, PA 15317-2685 2019-08-13
1174007314 Stephanie I Ellis Social Worker 555 Towner St, Ypsilanti, MI 48198-5723 2018-09-24
1760969604 Stephanie Ellis Behavior Technician 1363 Douglas Dr, Traverse City, MI 49696-8980 2018-07-24
1689161879 Stephanie Ellis Pharmacist 7393 Jackson Dr, San Diego, CA 92119-2316 2018-04-13

Office Location

Street Address 4909 N GLEN PARK PLACE RD
City PEORIA
State IL
Zip Code 61614-4676

Providers in the same location

NPI Name Taxonomy Address Enumeration
1174599260 Chen Wang Pathology 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2006-02-27
1790180164 Sara Snarr Nurse Practitioner 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2014-10-28
1700209160 Sarah Christensen Physician Assistant 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2014-01-21
1134481054 Nour Almardini Pathology 4909 N Glen Park Place Rd, Peoria, IL 61614-4689 2012-06-15
1245490382 Tesfu Hailu Dermatology 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2008-06-12
1477743813 Michelle L Roth Physician Assistant 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2007-08-01
1073655676 James Murray Jeffries IIi Surgery 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2007-02-12
1912017245 Michael L Hayes Dermatology 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2006-08-30
1871506931 John R Soderstrom Physician Assistant 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2006-08-13
1710931670 Soderstrom Dermatology Center S C Pathology 4909 N Glen Park Place Rd, Peoria, IL 61614-4676 2006-05-22
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1548818511 Christine Svoboda Social Worker 6919 N Knoxville Ave Ste 100 and 202, Peoria, IL 61614 2019-09-03
1639649007 Kathy Karouzos Counseling, LLC Clinic/Center 330 W. Ivy Ln., Peoria, IL 61614 2018-11-28
1205312790 Kathleen Marie Hendricks Nurse Practitioner 2809 W Willow Knolls Dr, Peoria, IL 61614 2018-07-17
1629563937 Mary Elizabeth Cunningham Counselor 6219 N. Eldorado Dr., Peoria, IL 61614 2018-06-28
1861937955 Angela Gilles Social Worker 6919 N Knoxville Ave Ste 100, Peoria, IL 61614 2016-12-27
1467994897 Melissa Saxsma Specialist 5009 N Executive Dr, Peoria, IL 61614 2016-11-16
1902258874 Rashid Plastic Surgery, LLC Plastic Surgery 804 W Trailcreek Drive, Peoria, IL 61614 2016-07-05
1215313143 Melissa Lynn Phelan Nurse Practitioner 122 E Morningside Dr, Peoria, IL 61614 2015-08-03
1811380165 All Ways Caring Services, Inc. In Home Supportive Care 6919 N Knoxville Ave, Suite 102, Peoria, IL 61614 2015-03-11
1568875920 Schuler & Arkwell Orthodontic Partnership Dentist 2425 Cornerstone Ct. Ste. A, Peoria, IL 61614 2014-06-03
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Taxonomy Information

Taxonomy Code 363A00000X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant

Taxonomy Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1275148280 Patricia Miriam Rus Physician Assistant 23615 N 105th Dr, Peoria, AZ 85383-1195 2020-09-15
1083235154 Katlyn Coyer Physician Assistant 900 Main St Ste 530, Peoria, IL 61602-1005 2020-04-30
1114586690 Courtney A Hitpas Physician Assistant 3120 N Bigelow St, Peoria, IL 61604-1628 2019-06-10
1689137671 Jeffrey Benjamin Miessau Physician Assistant 7707 N Knoxville Ave Ste 200, Peoria, IL 61614-2020 2019-04-08
1417413337 Michelle Nemeh Physician Assistant 6760 W Thunderbird Rd Ste 100, Peoria, AZ 85381-5048 2019-02-15
1730655572 Sylwia M. Budzik Physician Assistant 8600 Illinois Rt. 91, Suite 300, Peoria, IL 61615 2018-10-19
1962977538 Ashley Deyoung Physician Assistant 13943 N 91st Ave Ste F101, Peoria, AZ 85381-3689 2018-10-09
1326557141 Melissa L. Kingston Physician Assistant 13760 N 93rd Ave Ste 201, Peoria, AZ 85381-4200 2017-09-25
1396196465 Ayla Diamond Physician Assistant 9165 W Thunderbird Rd Ste 200, Peoria, AZ 85381-4847 2016-06-29
1336530948 Carolina C. Castro Physician Assistant 13128 N. 94th Drive, Suite 100, Peoria, AZ 85381-4252 2015-02-18
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Competitor

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City PEORIA
Zip Code 61614

Improve Information

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Dataset Information

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.

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