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General NPI Number Information
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NPI Number | 1437698073
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Entity Type | Individual
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Provider Name | STEPHANIE ALLYCE HANSON HIS
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Gender | Female
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Dates
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Enumeration Date | 02/15/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 11030 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53092-5009
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Country | US
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Telephone | 262-240-0288
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Fax | 262-240-0503
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Provider Business Mailing Address
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Address Line | W57N709 HAWTHORNE AVE APT 3
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City | CEDARBURG
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State | WI
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Zip | 53012-1460
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Country | US
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Telephone | 414-940-4024
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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 | 237700000X
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Taxonomy Name | Hearing Instrument Specialist
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License Number | 1496-60
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License Number State | WI
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