Healthcare Provider Details

I. General information

NPI: 1083968143
Provider Name (Legal Business Name): STEPHANIE M. RABE ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2012
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 W GOOD HOPE RD
MILWAUKEE WI
53209-2042
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 414-352-3100
  • Fax:
Mailing address:
  • Phone: 414-389-2131
  • Fax: 573-815-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5119-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number5119
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number2019029637
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: