Healthcare Provider Details

I. General information

NPI: 1376474742
Provider Name (Legal Business Name): STEPHANIE HILL
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 W 9TH ST
FOND DU LAC WI
54935-4956
US

IV. Provider business mailing address

72 W 9TH ST
FOND DU LAC WI
54935-4956
US

V. Phone/Fax

Practice location:
  • Phone: 920-906-6520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number122600-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: