Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | 51127 | WI |
NPI | 1013139641 |
---|---|
Provider Name | Heather M Stefaniak |
First Address | Green Bay, WI 54311-6519 |
Second Address | Green Bay, WI 54311-6519 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 26/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
35105300 | (05) | WI |