MEDICARE: STEPHANIE KELLY DREW FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	SP011850	PA
2	363LF0000X	Family Nurse Practitioner	R212599-6	MN
3	163W00000X	Registered Nurse	RN585810	PA
4	363LF0000X	Family Nurse Practitioner	12021-33	WI
5	163W00000X	Registered Nurse	R212599-6	MN

General Provider Information

NPI Number	:	1235408691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE KELLY DREW FNP-C

Provider Business Mailing Address
First Line	:	2727 N MAYFAIR RD STE I
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-4400
Country	:	US
Telephone Number	:	414-727-0910
Fax Number	:	414-727-0920

Provider Business Practice Location Address
First Line	:	2727 N MAYFAIR RD STE I
Second Line	:
City	:	WAUWATOSA
State	:	WI
Zip	:	53222-4400
Country	:	US
Telephone Number	:	414-727-0910
Fax Number	:	414-727-0920

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	11/19/2025

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