Healthcare Provider Details

I. General information

NPI: 1467918375
Provider Name (Legal Business Name): STACIE A BINTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 11/23/2021
Certification Date: 11/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 W GREENFIELD AVE
WEST ALLIS WI
53214-4958
US

IV. Provider business mailing address

6609 W GREENFIELD AVE
WEST ALLIS WI
53214-4958
US

V. Phone/Fax

Practice location:
  • Phone: 414-257-8500
  • Fax: 414-257-8505
Mailing address:
  • Phone: 414-257-8500
  • Fax: 414-257-8505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9021
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: