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General NPI Number Information
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NPI Number | 1750958104
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Entity Type | Organization
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Legal Business Name | STELLAR CARE LLC
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 10625 W NORTH AVE STE 230
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City | MILWAUKEE
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State | WI
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Zip | 53226-2315
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Country | US
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Telephone | 414-249-5698
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Fax | 320-207-5719
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Provider Business Mailing Address
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Address Line | 10625 W NORTH AVE STE 230
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City | WAUWATOSA
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State | WI
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Zip | 53226-2315
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Country | US
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Telephone | 414-249-5698
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Fax | 320-207-5719
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHANNA MARIE JOHNSON
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Credential | NP
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Telephone | 414-573-0179
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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