MEDICARE: STEPHANIE SOTO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC0400X	Case Management Registered Nurse	107558	WI

General Provider Information

NPI Number	:	1265078513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE SOTO

Provider Business Mailing Address
First Line	:	3632 S 77TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-1146
Country	:	US
Telephone Number	:	414-334-8934
Fax Number	:

Provider Business Practice Location Address
First Line	:	3632 S 77TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-1146
Country	:	US
Telephone Number	:	414-334-8934
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2019
Last Update Date	:	11/21/2019

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Directions to “ STEPHANIE SOTO ” Practice Location

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