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General NPI Number Information
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NPI Number | 1629442124
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Entity Type | Individual
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Provider Name | STEPHANIE MARIE KRAUSE PA-C, MMS
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Gender | Female
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Dates
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Enumeration Date | 11/20/2015
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 1155 N MAYFAIR RD DEPARTMENT OF PLASTIC SURGERY
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City | MILWAUKEE
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State | WI
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Zip | 53226-3462
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Country | US
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Telephone | 414-955-4263
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Fax | 414-955-6286
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Provider Business Mailing Address
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Address Line | 1155 N MAYFAIR RD DEPARTMENT OF PLASTIC SURGERY
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City | MILWAUKEE
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State | WI
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Zip | 53226-3462
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Country | US
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Telephone | 414-955-4263
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Fax | 414-955-6286
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 3694-23
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License Number State | WI
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