| Doctor Name: | AMY LYNN STAKER |
| NPI Number: | 1063756492 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 209010035 |
| Business Practice Address: | 6447 Cermak Rd Berwyn, IL - 604022311 |
| Business Phone Number: | 7732541400 |
| Business Fax Number: | |
| Mailing Address: | 966 W 21st St, CHICAGO |
| State: | IL |
| Postal Code: | 606084511 |
| Phone Number: | 7732541400 |
| Fax Number: | |
| NPI Enumeration Date: | 11/26/2012 |
| NPI Last Update Date: | 03/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209010035 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |