Provider Demographics
NPI:1235408691
Name:DREW, STEPHANIE KELLY (CRNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KELLY
Last Name:DREW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:KELLY
Other - Last Name:GALLAGHER, BREVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7235 OHMS LN
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2148
Mailing Address - Country:US
Mailing Address - Phone:952-841-2345
Mailing Address - Fax:952-841-2346
Practice Address - Street 1:1000 GATEWAY CT STE 100
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-8541
Practice Address - Country:US
Practice Address - Phone:920-204-6758
Practice Address - Fax:888-720-0495
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN585810163W00000X
MNR212599-6163W00000X, 363LF0000X
PASP011850363LF0000X
WI12021-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse