Healthcare Provider Details

I. General information

NPI: 1821425216
Provider Name (Legal Business Name): STACY L SHULFER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 10/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 COUNTY ROAD XX
KRONENWETTER WI
54455-7933
US

IV. Provider business mailing address

5449 PINEWOOD DR
STEVENS POINT WI
54482-8818
US

V. Phone/Fax

Practice location:
  • Phone: 715-355-4040
  • Fax: 715-359-8461
Mailing address:
  • Phone: 608-516-8225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3159-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: