Healthcare Provider Details

I. General information

NPI: 1912379785
Provider Name (Legal Business Name): STEPHANIE WERNER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S 36TH AVE
WAUSAU WI
54401-3930
US

IV. Provider business mailing address

4005 COMMUNITY CENTER DR #202
WESTON WI
54476-4139
US

V. Phone/Fax

Practice location:
  • Phone: 855-607-8242
  • Fax: 715-848-0425
Mailing address:
  • Phone: 715-241-5404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number6692-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number6692 - 33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: