| Doctor Name: | MR. ROBERT DENNIS STALLEY |
| NPI Number: | 1114271418 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APN |
| License Number: | 209.009884 |
| Business Practice Address: | 4405 Weaver Pkwy Warrenville, IL - 605553269 |
| Business Phone Number: | 6309388850 |
| Business Fax Number: | 6309388849 |
| Mailing Address: | 4405 Weaver Pkwy, WARRENVILLE |
| State: | IL |
| Postal Code: | 605553269 |
| Phone Number: | 6309388850 |
| Fax Number: | 6309388849 |
| NPI Enumeration Date: | 11/08/2012 |
| NPI Last Update Date: | 08/19/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209.009884 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |