Healthcare Provider Details

I. General information

NPI: 1487417879
Provider Name (Legal Business Name): JESSICA MARY STOIBER AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2024
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W4401 STATE ROAD 29
SPRING VALLEY WI
54767-8311
US

IV. Provider business mailing address

W4401 STATE ROAD 29
SPRING VALLEY WI
54767-8311
US

V. Phone/Fax

Practice location:
  • Phone: 715-317-1185
  • Fax:
Mailing address:
  • Phone: 715-317-1185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number2023189444
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: