Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 9717-33 | WI |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 9717-33 | WI |
NPI | 1023652310 |
---|---|
Provider Name | Stephanie Jan Killoy |
First Address | Middleton, WI 53562-5531 |
Second Address | Madison, WI 53792-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/10/2019 |
Last Update Date | 13/01/2021 |