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General NPI Number Information
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NPI Number | 1003137498
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Entity Type | Individual
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Provider Name | KIM C STEPHENS LA.C
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Gender | Female
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Dates
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Enumeration Date | 06/20/2010
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Last Update Date | 06/20/2010
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Provider Practice Location Address
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Address Line | 5261 N PORT WASHINGTON RD
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City | MILWAUKEE
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State | WI
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Zip | 53217-4903
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Country | US
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Telephone | 414-332-6001
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Fax |
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Provider Business Mailing Address
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Address Line | 2902 N 75TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53210-1024
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Country | US
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Telephone | 414-899-3969
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 317-055
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License Number State | WI
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