Healthcare Provider Details

I. General information

NPI: 1528021003
Provider Name (Legal Business Name): CAROL L STEPHENSON L.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 09/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 DE VALERA
PLATTEVILLE WI
53818
US

IV. Provider business mailing address

1425 NORTH WATER APT.#11
PLATTEVILLE WI
53818-1435
US

V. Phone/Fax

Practice location:
  • Phone: 608-348-8369
  • Fax:
Mailing address:
  • Phone: 608-348-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: