| Doctor Name: | STACEY MCGUAN |
| NPI Number: | 1679978803 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP/BC |
| License Number: | 209012102 |
| Business Practice Address: | 935 E Division St Diamond, IL - 604161346 |
| Business Phone Number: | 8156348447 |
| Business Fax Number: | |
| Mailing Address: | 935 E Division St, DIAMOND |
| State: | IL |
| Postal Code: | 604161346 |
| Phone Number: | 8156348447 |
| Fax Number: | |
| NPI Enumeration Date: | 10/30/2014 |
| NPI Last Update Date: | 02/09/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 209012102 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |