Active NPI
Deidra J Stinson
- Registered Nurse
- Calumet City, IL
National Provider Identifier
1174110035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 041155868
- Practice address
- 470 Torrence Ave
Calumet City, IL 60409-2306 - Phone
- (708) 832-2943
- NPI assigned
- Dec 28, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 041155868 | IL | Primary |
Addresses
Primary practice location
470 Torrence Ave
Calumet City, IL 60409-2306
Mailing address
17622 Rosewood Dr Apt 3a
Lansing, IL 60438-1736
Phone (798) 638-0414
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041155868 | IL | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highland Park CVS, L.L.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609113600000",
"number": "1174110035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17622 ROSEWOOD DR APT 3A",
"city": "LANSING",
"state": "IL",
"postal_code": "604381736",
"telephone_number": "798-638-0414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "470 TORRENCE AVE",
"city": "CALUMET CITY",
"state": "IL",
"postal_code": "604092306",
"telephone_number": "708-832-2943"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STINSON",
"first_name": "DEIDRA",
"middle_name": "J",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-12-28",
"last_updated": "2020-12-28",
"certification_date": "2020-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IL",
"license": "041155868",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Calumet City, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.