Provider Demographics
NPI:1225296270
Name:NICOLE L B STERNITZKY MD SC
Entity Type:Organization
Organization Name:NICOLE L B STERNITZKY MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:L B
Authorized Official - Last Name:STERNITZKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:262-798-1910
Mailing Address - Street 1:20611 WATERTOWN RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-1871
Mailing Address - Country:US
Mailing Address - Phone:262-798-1910
Mailing Address - Fax:
Practice Address - Street 1:20611 WATERTOWN RD
Practice Address - Street 2:SUITE E
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-1871
Practice Address - Country:US
Practice Address - Phone:262-798-1910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI49347020207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34882600Medicaid
WI34882600Medicaid
WI268773Medicare PIN