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General NPI Number Information
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NPI Number | 1417132069
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Entity Type | Individual
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Provider Name | SANDRA A STOCKHAUSEN RN
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Gender | Female
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 08/11/2011
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Provider Practice Location Address
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Address Line | 205 VALLEY AVE
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City | WEST BEND
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State | WI
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Zip | 53095-5312
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Country | US
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Telephone | 262-338-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 205 VALLEY AVE
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City | WEST BEND
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State | WI
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Zip | 53095-5312
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Country | US
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Telephone | 262-338-1123
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 111138
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 111138
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License Number State | WI
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