Provider Demographics
NPI:1255688396
Name:STANGE, KATELYN K (NP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:K
Last Name:STANGE
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:2801 W KK RIVER PKWY
Mailing Address - Street 2:345
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3669
Mailing Address - Country:US
Mailing Address - Phone:414-649-7900
Mailing Address - Fax:414-694-7499
Practice Address - Street 1:2801 W KK RIVER PKWY
Practice Address - Street 2:345
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3669
Practice Address - Country:US
Practice Address - Phone:414-649-7900
Practice Address - Fax:414-694-7499
Is Sole Proprietor?:No
Enumeration Date:2012-08-08
Last Update Date:2021-11-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI4915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI462364949Medicare PIN
WI019940728Medicare PIN