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General NPI Number Information
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NPI Number | 1316839046
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Entity Type | Individual
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Provider Name | STACEY LYNN STEPHENS AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/17/2025
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 209 S CENTRAL AVE STE 300
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City | MARSHFIELD
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State | WI
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Zip | 54449-2836
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Country | US
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Telephone | 614-439-0203
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Fax |
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Provider Business Mailing Address
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Address Line | 225 W WASHINGTON ST STE 1500
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City | CHICAGO
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State | IL
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Zip | 60606-3485
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Country | US
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Telephone | 855-493-5523
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 17067-33
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License Number State | WI
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