Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 6159 | WI |
NPI | 1003205386 |
---|---|
Provider Name | Stacie Strong |
First Address | La Crosse, WI 54601-5429 |
Second Address | La Crosse, WI 54601-5098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2015 |
Last Update Date | 09/01/2015 |