=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003541418
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEPHANI PLACEK FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2022
-----------------------------------------------------
Last Update Date | 07/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3233A BUSINESS PARK DR STE 203
-----------------------------------------------------
City | STEVENS POINT
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54482-8861
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-344-4541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 253 THEILER DR
-----------------------------------------------------
City | TOMAHAWK
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54487-1733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-612-1513
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 1089433
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------