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General NPI Number Information
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NPI Number | 1376146472
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Entity Type | Individual
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Provider Name | STACEY ANNE ROEBKEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/19/2020
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | N51W24953 LISBON RD
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City | PEWAUKEE
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State | WI
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Zip | 53072-1403
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Country | US
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Telephone | 262-532-8691
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Fax |
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Provider Business Mailing Address
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Address Line | N51W24953 LISBON RD
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City | PEWAUKEE
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State | WI
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Zip | 53072-1403
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Country | US
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Telephone | 262-532-8691
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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 | 10470-33
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License Number State | WI
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