Provider Demographics
NPI:1235789199
Name:CROFT, STEPHANIE SHANE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:SHANE
Last Name:CROFT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W3632 ARTISAN DR
Mailing Address - Street 2:
Mailing Address - City:GLEN FLORA
Mailing Address - State:WI
Mailing Address - Zip Code:54526-9728
Mailing Address - Country:US
Mailing Address - Phone:219-863-5546
Mailing Address - Fax:
Practice Address - Street 1:900 COLLEGE AVE W
Practice Address - Street 2:
Practice Address - City:LADYSMITH
Practice Address - State:WI
Practice Address - Zip Code:54848-2116
Practice Address - Country:US
Practice Address - Phone:715-532-5561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0270027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
F09190747OtherAANP CERTIFICATION