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General NPI Number Information
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NPI Number | 1235789199
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Entity Type | Individual
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Provider Name | STEPHANIE SHANE CROFT FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2019
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Last Update Date | 09/12/2019
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Provider Practice Location Address
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Address Line | 900 COLLEGE AVE W
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City | LADYSMITH
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State | WI
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Zip | 54848-2116
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Country | US
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Telephone | 715-532-5561
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Fax |
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Provider Business Mailing Address
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Address Line | W3632 ARTISAN DR
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City | GLEN FLORA
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State | WI
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Zip | 54526-9728
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Country | US
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Telephone | 219-863-5546
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0270027
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License Number State | WI
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