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General NPI Number Information
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NPI Number | 1801278809
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Entity Type | Individual
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Provider Name | STEPHANIE WATERMAN APRN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 04/21/2021
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Provider Practice Location Address
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Address Line | 1100 BERGSLIEN ST
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City | BALDWIN
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State | WI
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Zip | 54002-2600
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Country | US
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Telephone | 715-684-1111
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Fax | 715-684-1119
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Provider Business Mailing Address
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Address Line | 5300 N INDEPENDENCE AVE SUITE 280
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-5556
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Country | US
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Telephone | 580-482-9020
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Fax | 580-480-3113
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 103947
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 7368
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License Number State | WI
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