Healthcare Provider Details

I. General information

NPI: 1568837490
Provider Name (Legal Business Name): STACIE OPAHLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2015
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W156N8327 PILGRIM RD STE 408
MENOMONEE FALLS WI
53051-3776
US

IV. Provider business mailing address

625 RIDGE DR
COLGATE WI
53017-9527
US

V. Phone/Fax

Practice location:
  • Phone: 414-395-8106
  • Fax: 414-386-0406
Mailing address:
  • Phone: 920-213-8997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: