Healthcare Provider Details

I. General information

NPI: 1972328599
Provider Name (Legal Business Name): JACKI J STELZEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 W BROADWAY AVE
MEDFORD WI
54451-1307
US

IV. Provider business mailing address

811 W BROADWAY AVE
MEDFORD WI
54451-1307
US

V. Phone/Fax

Practice location:
  • Phone: 715-748-5580
  • Fax: 715-748-5582
Mailing address:
  • Phone: 715-748-5580
  • Fax: 715-748-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16332
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number141546-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: