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General NPI Number Information
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NPI Number | 1497774830
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Entity Type | Individual
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Provider Name | MARY GWEN STEFFEN A.P.N.P.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 777 ALGOMA BLVD
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City | OSHKOSH
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State | WI
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Zip | 54901-3534
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Country | US
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Telephone | 920-424-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 429 REDMAN DR
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City | RIPON
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State | WI
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Zip | 54971-1268
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Country | US
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Telephone | 920-748-6332
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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 | 163WC1400X
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Taxonomy Name | College Health Registered Nurse
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License Number | 74614-030
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 163WC1400X
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Taxonomy Name | College Health Registered Nurse
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License Number | 907-033
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License Number State | WI
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