Provider Demographics
NPI:1235164229
Name:STANKO, HEATHER ALISSA (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALISSA
Last Name:STANKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:725 S WEBSTER SUITE 201
Mailing Address - Street 2:NEUROLOGY CONSULTANTS
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54301
Mailing Address - Country:US
Mailing Address - Phone:920-430-7100
Mailing Address - Fax:920-430-7114
Practice Address - Street 1:725 S WEBSTER SUITE 201
Practice Address - Street 2:NEUROLOGY CONSULTANTS
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301
Practice Address - Country:US
Practice Address - Phone:920-430-7100
Practice Address - Fax:920-430-7114
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI414912084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34469200Medicaid
WI34469200Medicaid
I02494Medicare UPIN