MEDICARE: MRS. MICHELLE IRENE STABBE LPN

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	164W00000X	Licensed Practical Nurse	31305-031	WI
2	164X00000X	Licensed Vocational Nurse	31305-031	WI

General Provider Information

NPI Number	:	1780647917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE IRENE STABBE LPN

Provider Business Mailing Address
First Line	:	8348 FOLEY RD
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-9521
Country	:	US
Telephone Number	:	262-639-1648
Fax Number	:

Provider Business Practice Location Address
First Line	:	8348 FOLEY RD
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53402-9521
Country	:	US
Telephone Number	:	262-639-1648
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	09/11/2025

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