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NPI Code Detail

MEDICARE: MONICA STOUT

MEDICARE: MONICA STOUT
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
1363L00000XNurse Practitioner89044-030WI

General Provider Information

NPI Number : 1780706739
Entity Type Code : Individual
Provider Name (Legal Business Name) : MONICA STOUT
Provider Business Mailing Address
First Line : 600 E LOCUST ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53212-2545
Country : US
Telephone Number : 414-372-3748
Fax Number :
Provider Business Practice Location Address
First Line : 2207 W WISCONSIN AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-1923
Country : US
Telephone Number : 414-931-8181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2007
Last Update Date : 07/08/2007

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Directions to “ MONICA STOUT ” Practice Location

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