Healthcare Provider Details

I. General information

NPI: 1336621713
Provider Name (Legal Business Name): KARLA L STUMPP APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2018
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MINISTRY PKWY
WESTON WI
54476-5220
US

IV. Provider business mailing address

3400 MINISTRY PKWY
WESTON WI
54476-5220
US

V. Phone/Fax

Practice location:
  • Phone: 715-393-1000
  • Fax: 715-393-1469
Mailing address:
  • Phone: 715-393-1000
  • Fax: 715-393-1469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8303066-4405
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9668
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: