Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 4301502411 | MI |
N | 2086S0129X | Vascular Surgeon | 61552 | MN |
Y | 2086S0129X | Vascular Surgeon | 70750 | WI |
NPI | 1114261591 |
---|---|
Provider Name | Dr. Stacey Rae Lejeune |
First Address | Wausau, WI 54401-7803 |
Second Address | Wausau, WI 54401-7803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2012 |
Last Update Date | 04/01/2021 |