| Doctor Name: | MS. STACEY K ROLINE |
| NPI Number: | 1003187469 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 085.004160 |
| Business Practice Address: | 1775 Dempster St Park Ridge, IL - 600681143 |
| Business Phone Number: | 8477232210 |
| Business Fax Number: | 8476927915 |
| Mailing Address: | 1775 Dempster St, PARK RIDGE |
| State: | IL |
| Postal Code: | 600681143 |
| Phone Number: | 8477232210 |
| Fax Number: | |
| NPI Enumeration Date: | 01/17/2012 |
| NPI Last Update Date: | 01/17/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 085.004160 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |