Healthcare Provider Details

I. General information

NPI: 1619141785
Provider Name (Legal Business Name): STEPHANIE R NIEC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE R NIEC-WELLS MD

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 THEATER RD
ONALASKA WI
54650-8679
US

IV. Provider business mailing address

200 1ST ST SW
ROCHESTER MN
55905-0001
US

V. Phone/Fax

Practice location:
  • Phone: 608-392-5000
  • Fax:
Mailing address:
  • Phone: 608-785-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55957
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: