Healthcare Provider Details

I. General information

NPI: 1750958104
Provider Name (Legal Business Name): STELLAR CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10625 W NORTH AVE STE 230
MILWAUKEE WI
53226-2315
US

IV. Provider business mailing address

10625 W NORTH AVE STE 230
WAUWATOSA WI
53226-2315
US

V. Phone/Fax

Practice location:
  • Phone: 414-249-5698
  • Fax: 320-207-5719
Mailing address:
  • Phone: 414-249-5698
  • Fax: 320-207-5719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SHANNA MARIE JOHNSON
Title or Position: PRESIDENT
Credential: NP
Phone: 414-573-0179