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General NPI Number Information
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NPI Number | 1205451762
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Entity Type | Individual
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Provider Name | STEPHANIE ENGEBRETSON OD
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Gender | Female
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Dates
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Enumeration Date | 06/10/2020
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Last Update Date | 12/28/2021
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Provider Practice Location Address
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Address Line | N54W6135 MILL ST
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City | CEDARBURG
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State | WI
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Zip | 53012-2021
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Country | US
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Telephone | 262-421-4412
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Fax |
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Provider Business Mailing Address
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Address Line | 458 W FOSTER ST
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City | PORT WASHINGTON
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State | WI
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Zip | 53074-2110
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Country | US
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Telephone | 715-630-5032
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3618-35
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License Number State | WI
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