Healthcare Provider Details

I. General information

NPI: 1093649535
Provider Name (Legal Business Name): STORMY GALE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924 STATE HIGHWAY 42
FISH CREEK WI
54212-9625
US

IV. Provider business mailing address

3924 STATE HIGHWAY 42
FISH CREEK WI
54212-9625
US

V. Phone/Fax

Practice location:
  • Phone: 920-868-3284
  • Fax: 920-868-2714
Mailing address:
  • Phone: 920-868-3284
  • Fax: 920-868-2714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number252075
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: