Healthcare Provider Details

I. General information

NPI: 1700102761
Provider Name (Legal Business Name): ANN ELIZABETH STANTON APNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2010
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6185 S 116TH ST
HALES CORNERS WI
53130-2462
US

IV. Provider business mailing address

6185 S 116TH ST
HALES CORNERS WI
53130-2462
US

V. Phone/Fax

Practice location:
  • Phone: 920-973-3021
  • Fax:
Mailing address:
  • Phone: 920-973-3021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number13348-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number154951-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: