Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5646 | WI |
N | 363LA2200X | Nurse Practitioner - Adult Health | 5646 | WI |
N | 363LG0600X | Nurse Practitioner - Gerontology | 5646 | WI |
NPI | 1063835288 |
---|---|
Provider Name | Allsion R Stache |
First Address | New London, WI 54961-2155 |
Second Address | New London, WI 54961-2155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2014 |
Last Update Date | 08/09/2021 |