Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 63044 | WI |
Y | 207VE0102X | Reproductive Endocrinologist | 63044 | WI |
NPI | 1366785065 |
---|---|
Provider Name | Dr. Stephanie Jean Gunderson |
First Address | Menomonee Falls, WI 53051-0538 |
Second Address | Menomonee Falls, WI 53051-0538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2013 |
Last Update Date | 01/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1366785065 | (05) | WI |