Provider Demographics
NPI:1003541418
Name:PLACEK, STEPHANI (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANI
Middle Name:
Last Name:PLACEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 THEILER DR
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-1733
Mailing Address - Country:US
Mailing Address - Phone:715-612-1513
Mailing Address - Fax:
Practice Address - Street 1:3233A BUSINESS PARK DR STE 203
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8861
Practice Address - Country:US
Practice Address - Phone:715-344-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1089433363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner